Situation analysis for management of abnormal Pap smears in the lower southern Thailand.

ABSTRACT

OBJECTIVE: To identify the resources for management of abnormal Pap smears and the treatment facilities in pre-invasive cervical neoplasia in the lower southern Thailand. METHODS: After reviewing the necessary data, an expert meeting was scheduled for questionnaire development. The questionnaires were then sent to the general, regional, and university hospitals in the lower southern Thailand for self-evaluation and on-site visits were made for intensive interviews, exploring the services and treatment facilities for women with abnormal Pap smears. RESULTS: All of the 12 target hospitals provided passive cervical cancer screening although the quality of cytological services was obscure and the process of patient notification for the results of the abnormal Pap smears was not convincing. There was a limitation in the pathological laboratory services. The incidence of the abnormal Pap smears in the one-year period of the study, defined as atypical squamous cells of undetermined significance (ASCUS) or above and high grade squamous intraepithelial lesions (HSIL) or above were 1.24% (95% CI 1.15-1.32) and 0.36% (95% CI 0.30-0.43) respectively. All but one hospital reported having a colposcope, but only one could provide standard colposcopy services. The efficiency of the referral system is questionable. CONCLUSION: The resources for the management of abnormal Pap smears as well as the conventional referral system need to be reorganized. The data from this survey support the concept of a centralized colposcopy service with the University hospital as suitable place for the referral center. Two further 2 hospitals have potential for future development as referral centers.