STUDY AND ANALYSIS OF CERVICAL PAP SMEARS IN A MEDICAL COLLEGE HOSPITAL

Introduction: Cervical cancer is the second most common gynaecological cancer worldwide and the third leading cause of cancer-related mortality in the less developed countries. Cervical cancer may be prevented or diagnosed at early stages due to the easy accessibility and clinical evaluation of the cervix. A pap test is a simple, easy, painless procedure which can be carried out as an outpatient procedure to detect specic, nonspecic inammations, precancerous and cancerous lesions In our study we have analysed the results of PAP smears of women in all age groups and have tried to evaluate the prevalence of cervical lesions and the importance of cervical cancer screening. Material And Methods: Our study was conducted between October 2020 to JULY 2021 and patients who have visited the Gynaec OP during this period were included for this study. We received Pap smears from the Department of Obstetrics and Gynecology, stained the slides with Pap stain and studied the smears according to the new Bethesda System for Reporting Cervical Cytology 2014. Results: In our study, majority of the patients were in the age group of 41-50 years. Smears showing ASCUS were 14 , LSIL reports were 5, HSIL reports were 4. No Smears showed squamous cell carcinoma in our study. Reports in our study like many other studies has shown the importance of Pap smear test in screening cervical cancer. By conducting health camps, increasing health awareness and performing Pap smear screening programmes the incidence of cervical carcinoma can be decreased.

Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake: a dynamic interplay between public health policy and welfare state redistribution

Background While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake. Aim This study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10′000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake. Methods A two-level design with 25–64-year-old women (N = 96′883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey’s second wave, using multilevel logistic regression modelling. Results Clear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification. Conclusion This study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

PURPOSE We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. MATERIALS AND METHODS A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. RESULTS There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. CONCLUSION The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries.

Pap smear screening in antenatal women: an opportunistic way to save life

Background: Cancer cervix is the most common genital tract malignancy encountered in developing countries. In India, first visit to the gynaecologist for most women is during pregnancy and it may be the only visit. Hence, prenatal care offers an excellent opportunity to implement cervical screening in patients of young age, especially in women who do not seek routine health care. Therefore, this study was conducted to know the prevalence of abnormal Pap smear among the ante-natal women and to evaluate the result in relation to various risk factors.Methods: Cross sectional observational study conducted on 425 ante-natal women attending the antenatal clinic using questioner addressing various socio-demographic variables. Measures of central tendency calculated and result was tabulated by using chi-square test.Results: Maximum number of cases in our study was NILM i.e.314 (74%) followed by 68 cases of Candida (16%), 30 cases of Bacterial vaginosis (7.1%) and 10 cases of Trichomonas vaginalis (2.4%). Only 3 cases of abnormal Pap smear was reported i.e. 2 of ASCUS and 1 of LSIL. Thus, prevalence of abnormal Pap smear was 0.7%.Conclusions: In country like India where organised screening programme are not available, as well as the awareness and uptake of available services by the target population is also poor; screening in pregnancy is worthwhile and may be a viable option to reduce the burden of cervical carcinoma.

Genetic Screening of Cervical Cancer

Medical genetics plays an important role in the screening and prevention of numerous diseases. Thus, it is important to develop effective screening and prevention programs and improve the assessment of the susceptibility of diseases. The development of screening and prevention programs depends on the identification of early biomarkers (including functional and behavioral) for the risk and onset of the disease, and such programs need to be designed according to internationally accepted criteria. Cervical cancer represents a very relevant disease from the health and social perspective; around 528,000 new cases are diagnosed every year globally, of which, 85% are from developing countries, representing almost 12% of all cancers in females. Substantial reductions in the incidence of and mortality from cervical cancer have been observed after the introduction of prevention campaigns with the implementation of cervical screening programs through Papanicolaou (Pap) tests and, in particular, following the introduction of organized programs which guarantee a high level of screening coverage, as well as, the quality and continuity of diagnostic-therapeutic procedures. It is estimated that Pap smear screening every 3-5 years provides 80% protection against the onset of cancer. Advances in diagnostic techniques, particularly the development of easy-to-use molecular genetic tests, are replacing the use of the established Pap smear as a screening tool. This is possible owing to the discovery in 1975 that some cellular morphological changes (koilocytosis) were related to the presence of a Human Papillomavirus (HPV) infection. The HPV test is performed on a small sample of cells taken from the cervix, similar to the Pap test; however, it is not a morphological exam but a molecular biology exam that detects the presence of HPV by identifying its deoxyribonucleic acid (DNA) or messenger ribonucleic acid (mRNA). The results of numerous experimental studies have demonstrated a greater sensitivity of this test compared to the sensitivity of the traditional Pap test. However, the HPV test has a lower specificity due to two main factors: 1) The HPV test is based on the search for the types of viruses that have a greater oncogenic potential, and 2) It does not discriminate between transient infections and persistent and productive infections. The most widely used molecular tests are based on the search for HPV sequences and genotyping using molecular biology techniques, such as direct hybridization, qualitative polymerase chain reaction (PCR), and viral nucleotide sequencing.

Women’s Participation in Pap Smear Screening in a Developing Country: Evidence for Improving Health Systems

IntroductionEvery year about 83,000 women are diagnosed with cervical cancer in the Americas. Latin America and the Caribbean (LAC) has one of the highest incidence and mortality rates from cervical cancer in the world. Although incidence has decreased by half in the last 30 years, cervical cancer remains a public health concern. The detection of precursor lesions through Papanicolaou (Pap) smear remains a critical tool in the context of prevention in Costa Rica and many other LAC countries.ObjectiveTo determine predictors of participation in Pap smear screening among Costa Rican women, with a special focus on women who have never had a Pap smear or have had a smear 5 or more years ago.MethodsThe data source for this study is the Costa Rican Households National Survey conducted in 2014. This survey is representative at the national, urban/rural zone, and administrative region level. A subsample of women aged 20 to 69 years who responded to the survey’s Papanicolaou Module were included in this study (n = 11,709). Statistical analyses were conducted in R-Studio. Statistical significance level was set at 5%. Two multinomial regression models were estimated. The first model aimed to explain the five different categories of cytology use, which were defined according to the last time women had a Pap smear. The second model aimed to explain the five different categories of reasons why women had never had a Pap smear. Both models controlled for age, educational attainment, and marital status.ResultsYoung women with high educational attainment were more likely to have never had a cytology. Women with a lower educational attainment, married, or in domestic relationship and of older age had greater odds of having had a cytology 5 or more years ago. Each year increment in age was significantly associated with an increase in the odds of never having a Pap smear because of health care access issues or because of cultural reasons as compared to not having an active sexual life.ConclusionsFindings can inform public policy targeted to higher risk female populations where access to health services can be improved.

Prevalence of cervical abnormalities amongst HIV-positive women

To study the prevalence and variety of cervical squamous intra-epithelial lesions (SIL) by Pap smear screening as an indicator of suspected HPV infection among HIV-infected women in Surat, Gujarat, India.All consecutive asymptomatic HIV seropositive women 18 years and older and attending the Anti-Retroviral Therapy Centre at New Civil Hospital, Surat, India between October 2009 to September 2011 were eligible for inclusion in the study. Participants constituted 439 asymptomatic HIV seropositive women receiving care at the ART centre underwent detailed history taking, physical examination and Pap smear screening. The incidence of SIL was 8.7% (38/439) in the participants. Further, statistical significance (p value &#62; 0.05) was observed in parity more than two, lost their husband, duration of marriage more than 10 years and CD4 count greater than 250.An association between HIV infection with pre-invasive changes in the cervical epithelium is noted. Early detection and prompt treatment of these changes after a thorough understanding of the natural history of disease in these women would go a long way in improving the survival as well as the quality of life in this increasing seropositive younger population.

Cancer Prevention Behaviors and Knowledge of Cancer Screening Among Food Insecure College Students

Objectives The objective of the current study were to examine cancer prevention knowledge and risky behaviors by diet and food insecurity. Methods A cross-sectional examination of college students examined FI status and cancer prevention behavior (fruit and vegetable intake (FVI), alcohol intake frequency (AIF), and tobacco use (TU)) and screening knowledge (age to receive breast, cervical, lung, prostate, and colon screening for “normal risk”). Results Students were 34.13% food insecure. Body mass index was significant by food insecurity status (P &lt; .01; FI = 26.41 kg/m2, Food Secure (FS) = 23.42 kg/m2). FVI was not significant by group however average intake of the whole population was 3.04 + 1.84 servings. Likewise, AIF by group was not significant (P &gt; .05). A higher percentage of FI used tobacco (P = .01). Lung and pap smear screening age knowledge by FI status was significantly different (P = .027 and .047, respectively). Conclusions As FI is correlated with negative health outcomes, upstream interventions should be proposed to target long term impacts such as risky behaviors and cancer prevention knowledge. Funding Sources University of Kentucky Start-up funds.

Barriers to Pap Smear Screening Among Medical Students: A Qualitative Study

ObjectiveThis study aims to explore the Pap smear screening barriers among medical students.MethodologyThis study was a qualitative study conducted among forty-one medical students. Ten female and 31 male. Four focus group discussions were included in this study. The focus groups consisted of one female group and three male groups. The obtained data were sorted into categories based on content analysis and data were analyzed manually.ResultsA total of 41 medical students participated in this qualitative study. Most of the study participants were male and 22 years of age. All groups reported that the lack of awareness is the main barrier to Pap smear screening. The conservative culture and the traditions of the people, shame of doing a pap test despite the gender of healthcare workers, and not trusting the healthcare workers were some of the other key barriers to Pap smear screening among the groups. It was also reported that the man has the final decision as to whether his wife will get a Pap smear screening. Finally, fear of the disease and/or fear of the complications of the test were also considered barriers to Pap smear testing. All groups were willing to suggest this test to their families and friends to prevent and treat the disease as early as possible. All groups agreed that the gender of the healthcare worker matters and definitely will affect a woman's decision whether to do the Pap smear screening or not. All girls preferred to be examined by a female. All the groups mentioned that the advantage of Pap smear screening is to diagnose and treat the disease early. All groups thought that personal hygiene of the private parts is the most important prevention method for cervical cancer.ConclusionsLack of awareness is the main barrier to Pap smear screening. The gender of the healthcare worker also greatly affects women's decision to have a Pap smear test. Therefore, raising awareness about the importance of early detection of cervical cancer among the general population is urgently needed, considering the culture and the tradition of the people. Introducing the human papillomavirus (HPV) vaccine is highly recommended.