Trends In Cervical Pap Smear Cytology In A Tertiary Hospital: Implications For Cervical Cancer Screening In Low-Income Countries

Abstract

Background: Screening rate for cervical cancer in Nigeria is low and not much is known about the changing trend in the premalignant stages of the disease.Objective: To evaluate the trend of epithelial cell abnormality in the Pap smear in the past 10 years.Methods: A 10-year review of cervical smear cytology (2008 -2017) at a tertiary institution in Nigeria using clinical and histopathological records. There were 5850 cervical smear cytology during the period.Results: A total of 5212 (89.1%) were analyzed. The modal age ranged from 35 to 44years. Majority 4481 (85.9%) of the smears were negative (Negative intraepithelial lesion or malignancy). Smear unsatisfactory for interpretation accounted for 398(7.6%). The prevalence of abnormal Pap smear was 6.5% (CI 5.8% - 7.1%). ASCUS -3.5%, LSIL – 2.2%, HSIL – 0.4%, malignancy – 0.3% and ASC-H –o.1%. The mean age of women with malignant smear was 51.2 ± 10.0years; compared to 42.4± 10.7 and 46.4± 13.4years for LSIL and HSIL respectively. There was moderate increase in LSIL in 2012 and 2013 with a decline in 2014. However, the rate of LSIL, in the last 4years, increased from 3.5% to 17.9% (p<0.0001). HSIL increased from 15.8% in 2013 to 21.1% in 2015 but had a sharp decline afterwards. Malignant cytology rate fluctuated over the years without a specific pattern.Conclusion: Given the increasing rate of LSIL in this setting and late commencement of cervical screening among our women, there is an urgent need to increase the awareness of the benefits of early detection of cervical cancer using Pap smear.