Opportunistic cervical cancer screening by papanicolaou stain Pap smear among women: a pilot study at urban health training centre of All India Institute of Medical Sciences, Patna, Bihar, India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20202525Keywords:
Cervical cancer, Opportunistic screening, Pap smearAbstract
Background: Cancer of the uterine cervix is the second most common cancer among women world-wide and accounts for 17% of all cancer deaths among females aged 30-69 years in India. Locally advanced cervical cancer is rampant in Bihar because of the high prevalence of associated risk factors. However, there is lack of organized screening programmes and treatment facilities for these patients. Thus, the study aimed at screening women for cervical cancer opportunistically during their visit to the health centres and to assess the various socio-demographic and other risk factors associated with positive screening test results.
Methods: Using purposive sampling technique, all women aged 18-59 years who visited the centre for any purpose were interviewed using a pre-designed questionnaire. All eligible women were screened using the conventional Pap Smear and evaluation was done using the 2014 Bethesda system. This study is still underway and 71 women have been screened so far. An interim analysis was done.
Results: Only 4.23% of the women ever had Pap smear testing in their life earlier. Mean age was 35.3±9.12 years and majority of the women were married and multi-parous. Vaginal discharge (55.74%) was the most common perceived gynecological morbidity. Most (36.62%) smears were reported as inflammatory cervical smears while epithelial cell abnormalities were seen in 4 (5.63%) cases.
Conclusions: This study reiterates the need to start organized cervical screening program not only at tertiary center but also at primary health centers which will definitely help to reduce the burden to some extent
References
World Health Organization. WHO guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and women, 2013. Available at: https://www.who.int/reproductive health/publications/cancers/9789241505147/en/. Accessed 2nd May 2020.
Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol. 2016;37:278-85.
Government of India-WHO Collaborative Programme: Guidelines for Cervical Cancer Screening Programme, 2005. Available at: http://screening.iarc.fr/doc/WHO_India_CCSP_guidelines_2005.pdf. Accessed 1st May 2020.
Aswathy S, Javed R, Avani D. Epidemiology of cervical cancer with special focus on India. Int J Women Health. 2015;7:405-14.
Gahlot V, Kumar R. Epidemiology of cervical cancer in state of Bihar India: Hospital based study. Br J Med Health Res. 2016:3(9):7-14.
Kumari A, Pankaj S, Choudhary V, Kumari A, Nazneen S, Kumari J. Retrospective analysis of patients of cervical cancer a tertiary center in Bihar. Indian J Cancer. 2018;55:70-3.
Trivedi V, Chauhan R, Rani R, Singh U, Ghosh M. Cervical cancer in Bihar: an exploration of opportunities and challenges. Int J Current Res. 2017;9(5):50614-8.
Anderson GH, Boyes DA, Benedet JL, Le Riche JC, Matisic JP, Suen KC, et al. Organization and results of the cervical cytology screening programme in British Columbia. Brit Med J. 1988;296:975-8.
World Health Organization. Cervical Cancer Screening Programme: Managerial Guidelines, 1992. Available at: https://apps.who.int/iris/handle/ 10665/39478. Accessed 30th April 2020.
IARC. Working Group on Cervical cancer screening, 1987. Summary Chapter. In: Hakama M, Miller AB, Day NE, Eds. Screening for Cancer of the Uterine Cervix. Lyon, International Agency for Research on cancer: No.76 IARC Scientific publications; 1987:133-44.
WHO guidelines: Screening and treatment of precancerous lesions for cervical cancer prevention, 2013. Available at: http://apps.who.int/iris/bitstream/ 10665/94830/1/9789241548694_eng.pdf. Accessed on 29th April 2020.
Ratnam KP. Barriers to uptake of pap smear test for cervical cancer screening in semi-urban district of Andhra Pradesh-one-year study. IOSR J Dent Med Sci. 2018;17(2):37-40.
Miller AB, Nazeer S, Fonn S, Brandup-Lukanow A, Rehman R, Cronje H, et al. Report on consensus conference on cervical cancer screening and management. Int J Cancer. 2000;86:440-7.
Jacquiline S, Cristina H, Christopher E. Cervical cancer in developing world. West J Med. 2001;175:231-3.
Senapathy JG, Umadevi P, Kannika PS. The present scenario of cervical cancer control and HPV epidemiology in India: an outline. Asian Pac J Cancer Prev. 2011;12:1107-15.
Adab P, McGhee SM, Yanova J, Wong CM, Hedley AJ. Effectiveness and efficiency of opportunistic cervical cancer screening: comparison with organized screening. Med Care. 2004;42:600-9.
Kulkarni PR, Rani H, Vimalambike MG, Ravishankar S. Opportunistic screening for cervical cancer in a tertiary hospital in Karnataka, India. Asian Pac J Cancer Prev. 2013;14(9):5101-5.
Nayar R, Wilbur DC. The Bethesda System for reporting cervical cytology: definitions, criteria, and explanatory notes. 3rd ed. New York, Springer; 2015.
Saha D, Ghosh S, Nath S, Islam H. Utility of Pap smear screening for prevention of cervical cancer- A 3 yrs study from rural Tripura - a northeastern state of India. Int J Med Dent Sci. 2017;6(2):1456-61.
Verma A, Verma S, Vashist S, Attri S, Singhal A. A study on cervical cancer screening in symptomatic women using Pap smear in a tertiary care hospital in rural area of Himachal Pradesh, India. Mid East Fertil Soci J. 2017;22(1):39-42.
Shanmughum D, Vijay A, Rangaswamy T. Colposcopic evaluation of patient with persistent inflammatory pap smear. Sch J App Med Sci. 2014;2:1010-3.
Maleki A, Ahmadina E, Avazeh A, Mazloomzadeh S, Molaei B, Jalilvand A. Prevelance of abnormal papanicolaou test results and related factors among women living in Zanjan, Iran. Asian Pac J Cancer Prev. 2015;16:6935-9.
International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: State Factsheet Bihar. Mumbai: IIPS. Available at: http://rchiips.org/NFHS/pdf/NFHS4/BR_FactSheet.pdf. Accessed on 5th May 2020.
Castellsagué X and Muñoz N. Cofactors in human papillomavirus carcinogenesis-role of parity, oral contraceptives, and tobacco smoking. Journal of the National Cancer Institute. Monographs. 2003;3:20-8.
Desai M. An assessment of community-based cancer screening program among Indian Women Using the Anganwadi Workers. J Obstet Gynecol Ind. 2004:54:483-7.
Mishra P, Thapa R, Dinkar AK. A study on cervical cancer screening using pap smear in urban area in state of Meghalaya, India. Int J Reprod Contracept Obstet Gynecol. 2018;7:3113-6.
Omna S, Chakrabarty BK, Nagaraja N. A study on cervical cancer screening in asymptomatic women using Papanicolaou smear in a tertiary care hospital in an urban area of Mumbai, India. J Family Med Prim Care. 2018;7(4):652-7.
Sachan PL, Singh M, Patel ML, Sachan R. A study on cervical cancer screening using pap smear test and clinical correlation. Asia Pac J Oncol Nurs. 2018;5:337-41.
Padmini CP, Indira N, Chaitra R, Das P, Girish BC, Nanda KM, et al. Cytological and colposcopic evaluation of unhealthy cervix. J Evid Med Healthc. 2015;2:6920-7.
