Analysis of cervical smears in a Muslim population

Abstract

BackgroundScreening for cancer of the cervix remains a neglected health care issue in Pakistan. To provide baseline data for future efforts to improve screening, we conducted a retrospective analysis of cervical smears taken in the obstetrics and gynaecological clinics of the Aga Khan University Hospital, Karachi, Pakistan.MethodWe collected data on cervical smear cytology for cervical smears taken from January 1, 1990 to December 31, 1996. We assessed risk factors for dysplasia, including age, age at first marriage, and number of pregnancies.ResultsThe overall prevalence of abnormal smears in our study was 0.5%. Of 20,995 cervical smears, 12,451 (59.3%) smears showed non-specific inflammation, 7302 (34.8%) were reported as normal, 809 (3.85%) showed monillial infection, 148 (0.71%) showed atypia, 105 (0.5%) had dysplastic cytology, and 52 (0.25%) samples were inadequate. The highest incidence of dysplastic smears was seen in the age group 35 to 44 years. Of 105 patients with dysplasia, 12 were pregnant, and all were asymptomatic, while in 93 non-pregnant women, 33 were symptomatic.ConclusionThe low prevalence of abnormal smears, compared with data from Western populations, could be due to the inherent bias of health awareness in the women who attended our hospital. The results of this study may serve as a baseline for future comparisons. A larger community-based study may establish the exact prevalence of malignant and premalignant lesions so as to plan for future screening.

Changing Spectrum of Squamous Cell Abnormalities Observed on Papanicolaou Smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-Year Period

“…For counseling young women and for organizing a public health system it is important to know the incidence of cervical intraepithelial lesions in a country. A relatively low prevalence of abnormal smears and cervical cancer has been reported in the Muslim as compared with the Western population [6][7][8][9][10][11][12] . This is most likely related to sexual behavior under Islamic rules [10] , the lack of awareness of cervical cancer risk factors among women, and the low awareness that routine gynecological examinations and Pap smears are essential [11,13,14] .…”

Frequency of Cervical Pre-Malignancy in Pregnant Women

“…4 In another study, conducted at Karachi, Pakistan, cervical smear was taken in 20,995 cervical smears taken in the obstetrics and gynaecological clinics showed 0.71% atypia. 5 Another study conducted in India in which 300 pap smears were taken from patients who attended obstetrics and gynaecology showed cervical epithelial abnormalities in 5% of cases. 6 Every three yearly Pap smear is recommended in women aged 18 to 69 years, who have ever been sexually active.…”

“…4 Similarly, studies conducted in Pakistan and India screened both obstetrics and gynaecological patients showed up to 5% of cervical epithetlial abnormalities. 5,6 It means that study conducted in antenatal population showed high incidence of CIN as compared to both obstetrics and gynae patients. These studies indicated that pap smear is not taken regularly in reproductive age groups in Pakistan.…”

Cytological screening for cervical cancer in women of reproductive age group

“…3 The main risk factor for cervical cancer is infection with human papilloma virus (HPV) types 16,18,31,33,35,42,55,58. HPV types 16 and 18 are the cause of 70% of cervical cancer worldwide while 31 and 45 are the cause of another 10%.…”