Correlation between visual inspection of the cervix and pap smear test for cervical cancer screening

摘要

Cancer of the cervix, although a preventable disease has remained a common genital cancer in Nigeria, where most women rarely ever undergo cervical cancer screening. The reasons commonly cited in several studies for this abysmal situation are the absence of routine and organized screening programme, lack of knowledge about cervical cancer screening and cost. Visual inspection of the cervix, which is easy to do, cheap and does not require sophisticated material, elaborate training or technology has been advocated for low resource areas like Nigeria. The aim of this study was to assess the correlation between the observations on visual inspection of the cervix and the findings of the Pap smear among clinic attendees in a tertiary health care center. This is a prospective cross sectional study conducted at the Gynecological clinic of Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, South East Nigeria. This study shows that only 18 (12.9%) of the women were aware of cervical cancer screening test while 122 (87.1%) have never heard of the cervical cancer screening test before. Fifteen (83.3%) of those women who were aware of cervical cancer screening test got their information from health care providers, 2 (11.1%) from television and 1 (5.6%) from radio. However, 11 (61.1%) women out of the 18 respondents who were aware of cervical cancer screening test have done a Pap test before. Ninety six (68.6%) of the women had normal cervical smear while forty one (29.3%) had abnormal cervical smear. The proportion of unsatisfactory smear was 2.1%. The abnormal cervical smear was further sub-classified as LSIL (25 cases, 17.9%), HSIL (12 cases, 8.6%), ASC-US (3 cases, 2.1%) and glandular intraepithelial lesion (1 case, 0.7%). No case of squamous cell carcinoma was detected. The peak age prevalence of abnormal cervical smear was 40 to 44 years. A total of 24 suspicious looking cervixes were observed by visual inspection. There was significant association between the visual appearance of the cervix and the cervical smear result. Abnormal cervical smear was detected more among the women with suspicious cervical appearance on visual inspection (X2=10.45; Fisher exact = 0.003). Visual inspection of the cervix with unaided eye is a veritable tool in the routine screening of cancer of the cervix in poor resource areas. Most of the abnormal smear detected by the Pap test was among the women who had suspicious cervical appearance on visual inspection with an unaided eye. This is very interesting in that no special skill or extensive training is required before the widespread commencement of visual inspection of the cervix especially in hinterlands and resource poor areas.