ABSTRACT
Background: Cervical cancer is one of the leading cancers amongst women. Periodic pap screening is the simplest way to diagnose precancerous lesions. Factors such as ignorance, poverty poorly developed public healthcare delivery system put women in urban slums at a disadvantage for receiving any health screening activity. Objectives of the present study were to know the prevalence of epithelial cell abnormalities of the cervix among the subjects and to study the association with clinical and demographic characteristics. Methods: A camp based descriptive study was conducted in an urban ward. All women above the age of 20 years were included in the study. Data was recorded using a pretested questionnaire. Study variables included socio-demographic characteristics, symptoms of reproductive tract infection, findings of clinical examination, and Pap smear collection and evaluation. The latter was done from 194 women aged between 20-69 years. Pap smears were made by conventional Pap smear technique and reported according to The Revised Bethesda System of classification 2001(TBS). Results: Among the 194 women, in 8 subjects, the smears collected were unsatisfactory for evaluation. Analysis was done in the remaining 186 subjects. Among the latter, in 83.9%, the smears were negative for intraepithelial lesions (NIEL) and 16.1% revealed epithelial cell abnormalities (ECA). Among those with ECA, Atypical cells of undetermined significance (ASCUS) was identified in 66.67%, Low grade squamous intraepithelial lesions(LSIL) in 16.67%, Atypical squamous cells-cannot exclude HSIL (ASC-H) and Atypical glandular cells-not otherwise specified (AGC-NOS) in 6.67% each and High grade squamous intraepithelial lesions (HSIL) in 3.33%. Epithelial cell abnormalities were more common in women in the age group of 30-60 years (80%), they were more common in those with age at marriage between 13-18 years (63.3%) and in those with age at first child birth between 15-19 years (56.7%). Conclusions: Therefore there is a need for Pap screening at regular intervals through camp based approach in these populations to motivate the women, increase their awareness, ensure follow up and referral and timely intervention in appropriate cases.
ABSTRACT
BACKGROUND: PAP smear has been highly appraised for screening cervical cancer. Generally regarded is that women physicians regularly screen for PAP would promote patients' early detection and treatment rate by their strong recommendation. Hereby we investigated PAP-screening in primary care women physicians, recommending proportion and associated factors. METHODS: Questionnaires were sent to 981 members of the Korean Academy of Family Medicine, Korean Association of Family Practitioners, Korean Medical Women's Association, and Songpa-gu and Kangdong-gu family practitioners. a total of 193 respondents was analyzed. RESULTS: Among the total 55.4% of the respondents screened for PAP smear regularly, either annually (23.9%), or from their treating gynecologists (61.6%) or through routine check-up (81.1%). Common reasons for not screening were lack of time (40.7%) and forgetfulness (38.4%). Recommending proportion for PAP to patients was 49.2%. Reasons for not recommending were lack of equipment, forgetfulness (18.8% each). Confidence of PAP as a screening test was very high (71.5%); significantly related to PAP-screening and to recommending proportion (P=0.033, P=0.005, respectively). Many of the respondents thought physician's own PAP-screening affected its recommendation (45.3%), whereas significant relation to their actual PAP-screening was not found (P=0.845). PAP-screening in physicians showed no significant relationship with recommending proportion (P=0.053). Internal disease history had meaningful relation only with recommending proportion (P=0.001). CONCLUSION: Though physicians show strong confidence in PAP and undergo more than the general public, most do not screen for it regularly and the recommending proportion was low. To improve physician's PAP-screening and recommending proportion, re-education of physicians and provision of proper clinical equipment are required.