Sociodemographic and reproductive risk factors in cervical cancer

Tajinder Kaur, Shaveta Garg, Sunita Mor


Background: Cervical cancer is the leading cause of cancer deaths in women. In India, cervical cancer is the most common cancer in women followed by breast cancer. A numbers of risk factors reproductive as well as sociodemographic have been widely studied for cervical cancer. The countries where universal screening is restricted because of various reasons economical, lack of resources etcetera, a modified screening procedure which is targeted on the high risk population can help solve the problem.

Methods: This prospective study was conducted in a tertiary institute on sexually active women attending the gynaec OPD. A total of 200 women eligible for the study underwent a cytological evaluation and those with positive findings on Pap smear were followed by colposcopy directed biopsy. A detailed proforma including risk factors was filled for each patient and at the end of study data collected was tabulated in a master chart and was analyzed statistically.

Results: A total of 200 women underwent screening with Pap smear in present study. The Pap smear was normal in 93 (46.5%) of cases, 77 (38.5%) showed inflammatory smear and 3 (1.5%) subjects had an unsatisfactory smear. The Pap smear was abnormal in 27 (23.5%) of cases constituting 17 (8.5%) cases of LSIL, 2 (1%) of HSIL and 8 (4%) cases of AGS. All the women with LSIL and HSIL were subjected to colposcopy directed biopsy. Amongst 17 cases of LSIL on pap 8 came out as LSIL, 2 were HSIL and rest 7 were inflammatory after histopathological analysis. The 2 cases of HSIL on pap were confirmed as carcinoma in situ after biopsy. The maximum incidence of SIL of 16.66% was observed in age group of more than 40 years. The majority of cases of SIL, 12 (63.2%) had coitus before the age of 18 years. A positive correlation of SIL was seen with decreasing socioeconomic status, 8 (42.1%) of cases of SIL belonged to the low socioeconomic status while this group constituted only 23% of the total subjects.

Conclusions: The frequency of malignant and premalignant lesions was found to be significant, further emphasizing the importance of screening of cervical cancer. The prevalence of carcinoma cervix increases with age, in those with young age at first coitus, lower socioeconomic status and with low education level. A modified screening method can be an effective strategy to control cervical cancer in a developing country like India, where cost and manpower is an issue.


Cervical cancer, Pap smear, HSIL, LSIL, AGS

Full Text:



Parkin DM, Bray F, Ferley J. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94:153-6.

Rasda D, Jyothi V, Maratha J. A strategic assessment of cervical cancer prevention and treatment services. Reproductive health. 2005;2:11.

Louie KS, Sanjose SD, Diaz M, Castellsague X, Herrero R, Meijer CJ, et al. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. British Journal of Cancer. 2009;100(7):1191-97.

Genital Cancer. Tumours of the cervix uteri, Jeffcoats Principles of Gynecology. 7th ed.; 427-39.

Nayar R, Solomon D. Second edition of The Bethesda System for reporting cervical cytology-Atlas, website, and Bethesda interobserver reproducibility project. Cyto Journal. 2004;1:4.

Manos MM, Kinney WK, Hurley LB. Identifying women with cervical neoplasia: Using Human Papilloma virus DNA testing for equivocal papanicolaou results JAMA. 1999;281:1605-10.

Engineer AD, Misra JS. The role of routine outpatient cytological screening for early detection of carcinoma of cervix in India. Diagn Cytopathol. 1987;3(1);30-4.

Sherwani RK, Khan T, Akhtar K, Zeba A, Siddiqui FA, Rahman K, et al. Conventional Pap smear and liquid based cytology for cervical cancer screening- A comparative study. Journal of Cytology. 2007;24(4):167-72.

Luthra UK, Prabhakar AK, Seth P, Agarwal SS, Murthy NS, Bhatnagar P, et al. Natural history of precancerous and early cancerous lesions of uterine cervix. Acta Cytol. 1987;31(3):226-34.

Gehlot M, Hooja N, Lakhiwal MK. Correlation between colposcopy, cytology and histology in cervical lesions. J Obstet Gynecol India. 2001;51(5): 180-83.

Fonn S, Bloch B, Mabina M, Carpenter S, Cronje H, Maise C, et al. Prevalence of precancerous lesion and cervical cancer in South Africa-A Multicentric study. S Afr Med J. 2002;92(2):148-56.

Thulaseedharan VJ, Malila N, Hakama M, Esmy O P, Cheriyan M, et al. Socio demographic and reproductive risk factors for cervical cancer-a large prospective cohort study from rural India. Asian Pacific J Cancer Prev. 2012;13(6):2991-5.

Misra JS, Srivastava S, Singh U, Srivastava AN. Risk factors and strategies for control of carcinoma cervix in India: hospital based cytological screening experience of 35 years. Indian journal of cancer. 2009;46(2);155-9.

Herrero R, Brinton L, Reeves W, Brenes M, Tenorio F, Britton R, et al. Sexual behaviour, veneral disease, hygiene practices, and invasive cervical cancer in a high risk population. Cancer. 1990;65:380-5.

Varghese C, Amma NS, Chitrathara K, Dhakad N, Rani P, Malathy L, et al. Risk factors for cervical dysplasia in Kerela, India. Bulletin of World Health Organization. 1999;77(3):281-3.

Sharpley M, Jordan J, Croft PR. A systemic review of post coital bleeding and risk of cervical cancer. Br J Gen Pract. 2006;56(527):453-60.