Prevalence of abnormal Papanicolaou smear among women attending a tertiary care hospital in South Kerala

Abstract

Background: Cervical cancer remains an important preventable cause of morbidity and mortality among women, particularly where access to vaccination, screening and timely treatment is limited. Persistent infection with high-risk human papillomavirus (HPV) is the necessary cause of virtually all cervical cancers. Although HPV-based testing is now preferred by the World Health Organization (WHO) for primary screening, conventional Papanicolaou (Pap) cytology continues to be used in many clinical settings, including opportunistic screening. This study assessed the prevalence and pattern of abnormal Pap smear findings among women attending a tertiary care hospital in South Kerala and explored selected socio-demographic, reproductive and clinical characteristics.

Methods: This hospital-based cross-sectional study included 175 sexually active women aged ≥18 years attending the Department of Obstetrics and Gynaecology, SUT Academy of Medical Sciences, Vattapara, Thiruvananthapuram, from March to June 2021. Socio-demographic, reproductive and clinical information was collected using a pre-tested semi-structured questionnaire. Conventional Pap smears were obtained using an Ayre’s spatula, fixed immediately and reported according to the Bethesda System 2001. Data were analysed using SPSS version 25.0. Categorical associations were assessed using the Chi-square or Fisher’s exact test, as appropriate.

Results: Of 175 participants, 140 (80.0%) were aged ≥35 years. Four women (2.3%; 95% CI approximately 0.9-5.7%) had abnormal cytology, while 171 (97.7%) had negative for intraepithelial lesion or malignancy (NILM) reports. The abnormalities were LSIL in 2 (1.1%), ASC-US in 1 (0.6%) and squamous cell carcinoma in 1 (0.6%). Vaginal discharge was the commonest presenting complaint (32.0%), while bulky cervix (31.4%) and cervical erosion (26.3%) were the commonest per-speculum findings. All four abnormal smears occurred among women aged ≥35 years; however, the association between age group and abnormal cytology was not statistically significant (Fisher’s exact test, p=0.585).

Conclusions: Although the prevalence of abnormal Pap cytology was low in this hospital-based cohort, clinically important lesions, including LSIL and invasive squamous cell carcinoma, were detected. The findings support continued opportunistic screening and strengthen the case for systematic, high-quality cervical screening programmes. Pap cytology remains useful where it is available, while HPV-based primary screening should increasingly be incorporated in accordance with contemporary national and international guidance.