Risk-factors and strategies for control of carcinoma cervix in India: hospital based cytological screening experience of 35 years.

ABSTRACT

PURPOSE: Role of risk factors in cervical carcinogenesis and strategies for control of the disease have been assessed from the accumulated cytological data, derived from 35 years of hospital-based screening in Lucknow, North India. MATERIALS AND METHODS: A total of 36,484 women have been cytologically screened during a span of 35 years (April 1971 - June 2005) in the Gynaecology out patient department (OPD) of Queen Mary's Hospital. RESULTS: The frequency of Squamous Intraepithelial Lesion (SIL) and carcinoma was found to be 7.2% and 0.6%, respectively, in the present study. The study revealed high age and parity as a predominant factor in cervical carcinogenesis, while viral sexually transmitted disease (STDs) -human papilloma virus (HPV) and Herpes simplex virus (HSV) were also largely associated with SIL cases. The study emphasized great value of clinically downstaging the cervical cancer by detecting cervical cancer in the early stage. The study also revealed a significant difference in the frequency of SIL in symptomatic and asymptomatic women. CONCLUSION: Based on the analyzed data, it was felt that single lifetime screening, which appears to be the most feasible and affordable mode for control of carcinoma cervix in developing countries like India, should be carried out in all women of high parity irrespective of age (with three or more children) and in older women above the age of 40 years irrespective of parity.