The level of Pap test positivity and the factors associated with it among adult women in Fier, Albania

Abstract

Cervical cancer continues to remain a major concern for public health globally. The aim of this study was to determine the positivity level of the Pap test and the prevalence of cervical potentially pre-malignant and malignant lesions in a group of adult women aged 18 years and older in Fier Prefecture in Albania. Material and methods: This cross-sectional study included 1254 women who showed up for a Pap test at the gynecology service at the Fier Regional Hospital during 2013 and 2014. Basic socio-demographic data (age, place of residence, marital status), as well as data related to women’s gynecological history, including information related to menopause status, current pregnancy, menstrual cycle (regular or irregular), data on previous diseases of the genital tract, previous cytological examinations, and previous biopsies, was collected. Adequate cervical smears were interpreted, allowing the calculation of the prevalence of various cervical lesions. Binary logistic regression was used to identify factors associated with a positive Pap test result. Results: The average age of women in our study was 39.8 ± 10.7 years. About two-thirds of women resided in urban area, 99.1% were married at the time of the survey and 17.8% were in menopause. Only 1.8% of women had been subjected to a cytological examination in the past. Among the 1134 adequate cervical smears the level of positive Pap test result was 8.7% and the prevalence of LSIL, HSIL and ASC-US was 4.1%, 1.6% and 3%, respectively. No cases of squamous carcinoma were detected. Age was positively, strongly and significantly associated with a positive Pap result: compared to 21-30 years old women, those aged 31-40, 41-50 and >50 years were significantly 1.98, 6.09 and 14.07 times more likely to have a positive Pap test reading. There was a tendency for the Pap test positivity to be higher among urban woman, probably due to earlier initiation of sexual activity and more sexual partners compared to rural women. Only 2% of women had had cytological examinations in the past. Conclusions: The prevalence of abnormal Pap test among adult women in Fier prefecture was relatively high even though comparable to national and international studies. There is need to increase the awareness of women about cervical cancer and their participation in cervical cancer screening programs.