Association of Abnormal Pap Smear with Occult Cervical Stromal Invasion in Patients with Endometrial Cancer

Objective: The purpose of this study was to determine the association between abnormal preoperative Pap smearresults and occult cervical stromal invasion in endometrial cancer patients. Methods: Medical records were reviewed ofpatients with endometrial cancer who had undergone surgical staging at Srinagarind Hospital. Patients with gross cervicalinvolvement, with an unsatisfactory Pap smear, without available Pap smear results, with no cervical intraepitheliallesion/invasive cervical cancer, or who had previously undergone pelvic radiation therapy were excluded. The patientswere assigned to one of two groups according their Pap smear results (negative and epithelial cell abnormalities).Logistic regression was used to determine the independent association between an abnormal Pap smear and the riskof cervical stromal invasion. Results: All cervical smears in this study were performed as conventional Pap smears.Smears were abnormal in 50 (21.0%) of the 238 patients enrolled and normal in the remaining 188 (79.0%). The typesof Pap smear abnormalities included adenocarcinoma (n=22); atypical endometrial cells (n=2); atypical glandular cells(n=17); high-grade squamous intraepithelial lesions (n=4); atypical squamous cells, cannot exclude high-grade squamousintraepithelial lesions (n=2); and atypical squamous cells of undetermined significance (n=3). After controlling for type ofendometrial cancer, abnormal Pap smear results were found to be a significant independent factor that indicated cervicalstromal invasion (adjusted OR 2.65; 95% CI 1.35 to 5.21). Conclusion: Endometrial cancer patients with abnormalPap smears were strongly and independently associated with histopathologically diagnosed cervical stromal invasion.     

A population-based prospective study of Chlamydia trachomatis infection and cervical carcinoma

Persistent human papillomavirus (HPV) infection is an established cause of cervical cancer, but the role of other sexually transmitted agents, most notably Chlamydia trachomatis, has not been well defined. The women participating in the population-based cervical cancer screening program in V?sterbotten county of Northern Sweden were followed up for up to 26 years to identify 118 women who developed cervical cancer after having had a normal Pap smear (on average 5.6 years later; range 0.5 months-26 years). As controls, we selected another 118 women who were matched by birth cohort, time-point of sampling of the baseline normal smear and who had a normal smear at the time when the corresponding case was diagnosed with cancer. The Pap smears and cervical cancer biopsies were analyzed by PCR for C. trachomatis DNA and for HPV DNA. At baseline, C. trachomatis DNA was present in 8% of cases but not among any one of the controls. The relative risk for cervical cancer associated with past C. trachomatis infection, adjusted for concomitant HPV DNA positivity, was 17.1 (95% CI 2.6-infinity). The presence of C. trachomatis and of HPV were not interrelated. Whereas C. trachomatis was primarily found in specimens taken many years before cancer diagnosis, HPV DNA was associated with a short lag time before cancer diagnosis. Whereas most women who were HPV DNA-positive in the prediagnostic smear were also positive for the same virus in the cervical cancer biopsy, none of the women were positive for C. trachomatis in both the prediagnostic smear and in the subsequent cervical cancer. In conclusion, a prior cervical C. trachomatis infection was associated with an increased risk for development of invasive cervical cancer.     

Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8466 patients

In a prospective cohort study 8466 women attending routine cervical cancer screening were recruited. Colposcopy was performed on women with any degree of atypia on cytology and/or a positive high-risk human papillomavirus (HPV)-DNA test (HC2; Hybrid Capture 2((c))), and for a randomly selected sample of 3.4% women with negative findings on both. Quality control included reviews of cytology, histology, colposcopy images and retesting of samples with polymerase chain reaction. Test diagnostic performances were based on 7908 women who had complete baseline and follow-up results. Routine histology identified 86 women with high-grade cervical intraepithelial neoplasia (CIN2+), which was confirmed by review histology in only 46 cases. Sensitivity of routine cytology for the detection of CIN2+ was 43.5%, with a specificity, positive predictive value (PPV), negative predictive value (NPV) of 98.0, 11.4 and 99.7%, respectively. Sensitivity of the HC2 test for the detection of CIN2+ was 97.8%, with a specificity, PPV and NPV, of 95.3, 10.9 and 100%, respectively. No high-grade neoplasia was detected in the randomly selected control group. A negative HPV-test result, even in combination with a positive Papanicolaou (Pap) result, virtually excluded any risk of underlying high-grade disease, but this was not the case for a negative Pap result. These data show that HPV testing is of value for the detection or exclusion of prevalent CIN in a routine cervical cancer-screening setting and could be used for further risk classification of women for follow-up management.     

Extended duration of the detectable stage by adding HPV test in cervical cancer screening

The human papillomavirus test (HPV) test could improve the (cost-) effectiveness of cervical screening by selecting women with a very low risk for cervical cancer during a long period. An analysis of a longitudinal study suggests that women with a negative Pap smear and a negative HPV test have a strongly reduced risk of developing cervical abnormalities in the years following the test, and that HPV testing lengthens the detectable stage by 2-5 years, compared to Pap smear detection alone.     

Health Promotion Lifestyle and Cancer Screening Behaviors: A Survey among Academician Women

Breast self examination (BSE), screening mammography and Pap smear screening can significantly reducemortality from breast and cervical cancer. In an effort to understand the factors that influence BSE,mammography, and Pap smear behavior of woman academicians, we here explored the relation between healthpromotion life-style and women’s cancer screening practice. A total of 750 woman academicians working in auniversity were enrolled, 350 of them responding to the survey. The study instruments used were the HealthPromotion Life-Style Profile (HPLP) scale and a questionnaire of demographic data. There was a significantrelationship between age-group, marital status, presence of cancer in the family, history of cervical erosion anddoing BSE, having mammography and a Pap smear. Additionally, both the general mean and nearly all domainsof HPLP were significantly related to BSE, mammography, and Pap smear behavior. This study demonstratedstrong relationships between breast and cervical cancer screening behavior and health promoting lifestyle inthis subgroup of women, making an important contribution to understanding the factors influencing women’shealth behavior.     

Is Age an Independent Predictor of High-Grade Histopathology in Women Referred for Colposcopy after Abnormal Cervical Cytology?

This study was conducted to determine whether advancing age is an independent predictor of increased risk ofhigh-grade pathologies among women referred for colposcopy after abnormal cervical cytology. Medical recordswere reviewed for women with abnormal cervical cytology who underwent colposcopy at Khon Kaen UniversityHospital. Logistic regression was used to determine the independent impact of age on the risk of high-gradepathologies. Mean age of the women was 42.8 years. Of 482 women, 97 (20.1%) were postmenopausal, and 92(19.1%) were nulliparous. The rate of high-grade pathologies included cervical intraepithelial neoplasia 2-3, 99(20.5%), adenocarcinoma in situ, 4 (0.8%), cervical cancer, 30 (6.2%), and endometrial cancer, 1 (0.2%). Theprevalence of significant lesions was 26.9% (95% CI, 23.1%-31.2%). In total, 31 women had cancers (6.4%; 95%CI, 4.4%-9.0%). When controlling for smear types and parity, age was noted to be a significant independentpredictor of high-grade histopathology. Women older than 35-40 years were approximately 2 times as likelyto have severe histopathology as the younger women. This study illustrates the substantial risk of underlyingsignificant lesions especially invasive cancer in Thai women with abnormal cervical cytology. Age was a significantindependent factor predicting the risk of high-grade pathologies.     

Distribution of cervical and breast cancer risk factors in women and their screening behaviours

Breast cancer and cervical cancer are important causes of cancer‐related mortality in women all over the world. The present study was conducted in order to investigate the distribution of cervical and breast cancer risk factors in women and their knowledge and behaviours about cancer screening methods. The study is cross‐sectional in nature. It was conducted with the participation of 1,886 women in Turkey. Data were collected through a questionnaire. The knowledge and behaviours of women aged 40 and over about breast cancer or cervical cancer screening methods were investigated according to the education level; results showed that the rates of those who knew and did breast self‐examination were significantly lower in illiterate women. Besides, the rates of women who did breast self‐examination were significantly lower in those who were aged 40 and over, and the rates of those who had clinical breast examination and Pap smear test were significantly lower in women aged 39 and below (p < 0.01). This study identified the most notable breast and cervical cancer risk factors as low education levels, high number of deliveries, short breastfeeding period, obesity and low socio‐economic level. For this reason, public health policies should be developed to minimise these risk factors.     

Cervical Cancer Risk Levels in Turkey and Compliance to the National Cervical Cancer Screening Standard

Cervical cancer screening with Pap smear test is a cost-effective method. The Ministry of Health in Turkeyrecommends that it be performed once every five years after age 35. The purpose of this study was to determinethe cervical cancer risk levels of women between 35 and 69, and the intervals they have the Pap smear test,and to investigate the relation between the two. This study was performed on 227 women aged between 35and 69 living in Balcova District of İzmir province. Using the cervical cancer risk index program of HarvardSchool of Public Health, the cervical cancer risk level of 70% of the women was found below average, 22.1%average, and 7.9% above average. Only 52% of the women have had Pap smear test at least once in their lives.The percentage screening regularly in conformity with the national screening standard was 39.2%. Women inthe 40-49 age group, were married, conformed significantly more (p<0.05) to the national screening standard.Compliance also increased with the level of education and decreased with the cervical cancer risk level (p<0.05).A logistic regression model was constructed including age, education level, menstruation state of the women andthe economic level of the family. Not having the Pap smear test in conformity with the national cervical cancerscreening standard in 35-39 age group was 2.52 times more than 40-49 age group, while it was 3.26 times morein 60-69 age group (p<0.05). Not having Pap smear test in 35-39 age group more than other groups might resultfrom lack of information on the cervical cancer national screening standard and the necessity of having Papsmear test. As for 60-69 age group, the low education level might cause not having Pap smear test. Under thesecircumstances, the cervical cancer risk levels should be determined and the individuals should be informed.Providing Pap smear test screening service to individuals in the target group of national screening standard, asa public service may resolve the inequalities due to age and educational differences.     

Efficacy of a Training Course Given by Midwives Concerning Cervical Cancer Risk Factors and Prevention

Background: Cervical cancer is the second most common cancer type seen among women in most countriesand an important cause of mortality. Although it is a preventable disease, most women living in developingcountries cannot reach effective screening programs. It is essential that appropriate education about cervicalcancer is provided. Objective: This experimental field study was performed with the aim of evaluating theefficacy of training given to women about cervical cancer risk factors and primary and secondary preventionprecautions. Methods: The research focused on women between 25 and 29 years of age, literate, married andhaving social security. The study was conducted in the district of Evka 4 Health Care Center between the datesof April to August 2005. The women were given survey forms and questionnaires in order to determine theirsocio-demographic features and knowledge level about cervical cancer in the course of home visits. They weretrained and given a manual at the data collection stage. At a second visit, carried out three months later, thetrained women were again evaluated for their knowledge level about cervical cancer, risk factors and whetherthey had undergone a Pap smear test. Results: Together with the difference between pre-/post-training meaninformation scores related to women’s cervical cancer risk factors, the difference between the women’s havinga Pap smear test in the pre-/post-training period was found statistically significant. Only 16.3% of the womenstated that they had a Pap smear test in the post-training period. Conclusions: It was determined that thewomen were in need of knowledge about risk factors related to cervical cancer, prevention from and earlydiagnosis of cervical cancer, but there was no significant increase in the rate of having a Pap smear test despitethe increase in the knowledge level with the training given.     

Impact of screening on cervical cancer incidence: A population-based case–control study in the United States

Cervical cancer is widely preventable through screening, but little is known about the duration of protection offered by a negative screen in North America. A case–control study was conducted with records from population-based registries in New Mexico. Cases were women diagnosed with cervical cancer in 2006–2016, obtained from the Tumor Registry. Five controls per case from the New Mexico HPV Pap Registry were matched to cases by sex, age and place of residence. Dates and results of all cervical screening and diagnostic tests since 2006 were identified from the pap registry. We estimated the odds ratio of nonlocalized (Stage II+) and localized (Stage I) cervical cancer associated with attending screening in the 3 years prior to case-diagnosis compared to women not screened in 5 years. Of 876 cases, 527 were aged 25–64 years with ≥3 years of potential screening data. Only 38% of cases and 61% of controls attended screening in a 3-year period. Women screened in the 3 years prior to diagnosis had 83% lower risk of nonlocalized cancer (odds ratio [OR] = 0.17, 95% CI: 0.12–0.24) and 48% lower odds of localized cancer (OR = 0.52, 95% CI: 0.38–0.72), compared to women not screened in the 5 years prior to diagnosis. Women remained at low risk of nonlocalized cancer for 3.5–5 years after a negative screen compared to women with no negative screens in the 5 years prior to diagnosis. Routine cervical screening is effective at preventing localized and nonlocalized cervical cancers; 3 yearly screening prevents 83% of nonlocalized cancers, with no additional benefit of more frequent screening. Increasing screening coverage remains essential to further reduce cervical cancer incidence.     

HPV self‐sampling or the Pap‐smear: A randomized study among cervical screening nonattenders from lower socioeconomic groups in France

Today in France, low attendance to cervical screening by Papanicolaou cytology (Pap‐smear) is a major contributor to the 3,000 new cervical cancer cases and 1,000 deaths that occur from this disease every year. Nonattenders are mostly from lower socioeconomic groups and testing of self‐obtained samples for high‐risk Human Papilloma virus (HPV) types has been proposed as a method to increase screening participation in these groups. In 2011, we conducted a randomized study of women aged 35–69 from very low‐income populations around Marseille who had not responded to an initial invitation for a free Pap‐smear. After randomization, one group received a second invitation for a free Pap‐smear and the other group was offered a free self‐sampling kit for HPV testing. Participation rates were significantly different between the two groups with only 2.0% of women attending for a Pap‐smear while 18.3% of women returned a self‐sample for HPV testing (p ≤ 0.001). The detection rate of high‐grade lesions (≥CIN2) was 0.2‰ in the Pap‐smear group and 1.25‰ in the self‐sampling group (p = 0.01). Offering self‐sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions (≥CIN2) in comparison to the group of women receiving a second invitation for a Pap‐smear. However, low compliance to follow‐up in the self‐sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.     

Underlying Histopathology of HIV-infected Women with Squamous Cell Abnormalities on Cervical Cytology

This study was undertaken to evaluate the underlying histopathology of HIV-infected women who hadabnormal cervical cytology. HIV-infected women with abnormal cervical cytology undergoing colposcopy atChiang Mai University Hospital between January 2001 and February 2008 were reviewed. The cohorts werematched and compared with an HIV-negative group. During the study period, 65 HIV-infected women withabnormal cervical cytology were available for review. The abnormal cervical smears were atypical squamouscell (9), low-grade squamous intraepithelial lesion (22), high-grade squamous intraepithelial lesion (27), andsquamous cell carcinoma (7). When stratified by severity of abnormal cytology, HIV-infected women had ahigher risk of having cervical intraepithelial neoplasia II or higher, whether the cervical smear showed lowgrade(P=0.01) or high-grade abnormality (P=0.04) compared with the HIV negative group. After adjustmentby age, parity, and menopausal status, HIV-infected women had 2.56 times the risk of having CIN II or higher(69.2% of HIV-infected women compared with 47.7% of HIV negative women; 95% CI=1.21-5.40, P=0.01). Inconclusion, HIV-infected women with abnormal Pap smears are a population subset with higher risk of significantcervical lesions, irrespective of severity of abnormal cervical smears.     

Low risk of cervical cancer during a long period after negative screening in the Netherlands

A condition for effective cervical cancer screening is a low incidence of cervical cancer after negative screening compared to that in the absence of screening. This relative risk was studied for the period 1994-1997 in the Netherlands and compared with previous studies. All cases of invasive cervical cancer diagnosed from 1994 to 1997 in the Netherlands were related to woman-years at risk, stratified by age, number of preceding negative screenings and time since the preceding negative screening. These incidence rates were compared with that before screening started in the Netherlands. The relative risk increases from 0.13 in the first year after screening to 0.24 after more than 6 years after screening for women with one previous negative screening. These figures reduce to 0.06 and 0.18, respectively, for women with two or more previous screenings. However, these estimates are less favourable when account is taken of the likely decrease in risk for cervical cancer in the period studied. Our data show a low relative risk of cervical cancer for several years following the last negative Pap smear. However, the denominator of the relative risk, that is, the incidence without screening, may have been overestimated. This applies also to the IARC multicountry study, and may have caused too optimistic expectations about the effectiveness of cervical cancer screening.     

Comparison of Pap Smear Screening Results between Akha Hill Tribe and Urban Women in Chiang Rai Province,Thailand

Cervical cancer is an important woman’s health problems worldwide, especially in low socio-economiccountries. The aim of this study was to compare the Pap smear screening results between Akha hill tribe andurban women who live in Chiang Rai province, Thailand. Screening was conducted for 1,100 Akha women and1,100 urban women who came to have the Pap smear at Chiangrai Prachanukroh Hospital and 1 private cytologylaboratory from January to June 2008. The demographic characteristics and factors related to abnormal Pap􀁖􀁐􀁈􀁄􀁕􀁖􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀁖􀁈􀀃􀁚􀁒􀁐􀁈􀁑􀀃􀁚􀁈􀁕􀁈􀀃􀁊􀁄􀁗􀁋􀁈􀁕􀁈􀁇􀀃􀁘􀁖􀁌􀁑􀁊􀀃􀁆􀁏􀁒􀁖􀁈􀁇􀀃􀁐􀁒􀁇􀁈􀁏􀀃􀁔􀁘􀁈􀁖􀁗􀁌􀁒􀁑􀁑􀁄􀁌􀁕􀁈􀁖􀀑􀀃􀀤􀁅􀁑􀁒􀁕􀁐􀁄􀁏􀀃􀀳􀁄􀁓􀀃􀁖􀁐􀁈􀁄􀁕􀁖􀀃􀁚􀁈􀁕􀁈􀀃􀁇􀁈􀃀􀁑􀁈􀁇􀀃according to the Bethesda 2001 system. The results showed that the prevalence of abnormal Pap smears was12.2% in Akha women and 4.5% in urban women. The highest prevalence of Pap abnormalities was found inthe 41-50 years age group in both populations (4.5% in Akha and 1.7% in urban women). In both populations,abnormal Pap smears were found in <21 years age groups. From the questionnaires, the possible risk factors  related to the higher prevalence of abnormal pap amears in Akha woman wrew early age at marriage(17 years), high frequency pregnacies and high parity and no/low education level. In conclusion, cervical cancer control by education and early detection by Pap smear screening is necessary for hill tribe women. More Pap smear screening service units should be set to improve the coverage for the risk group women who got married in young age, especial in ethnic groups.     

Diagnostic Value of the CareTM HPV Test in Screening for Cervical Intraepithelial Neoplasia Grade 2 or Worse

Background: Cervical cancer is the fourth leading cause of cancer death in women worldwide. Persistent infection with a high risk human papillomavirus (HR-HPV) is the main etiological factor, so that early early detection of HR-HPV is very important. The aim of this study was to investigate the efficacy of CareTM HPV, a new method, as compared with Pap smear, PCR, and biopsy for screening purposes. Material and Method: In this cross-sectional study, 200 sexually active women aging from 25-50 years referred to the oncology clinic of Shahid Sodoughi Yazd Hospital in 2015 with a variety of cervix epithelial lesions or a need for colposcopy were enrolled. Results for CareTM HPV test (cervical), Pap smear, PCR, and biopsy were analyzed using SPSS 15 software and chi-square test, McNemar, and ROC curve analysis. Qualitative variables were compared using a Chi-square test. Results: CareTM HPV test sensitivity in detecting cervical intraepithelial neoplasia grade II (CIN-II) and also positive and negative predictive values were higher as compared to with other tests (p<0.05). The Pap smear test specificity was highest. There was no significant differences between CareTM HPV and PCR tests regarding detection of HPV-DNA in cases of CIN-II and worse (p>0.05). Conclusion: The CareTM HPV test has high sensitivity and predictive values for detecting HPV infection, with higher efficacy than the Pap smear test for tracking CIN-II. Therefore it may be recommended for use as a screening test in low-income areas.     

Molecular detection of cervical intraepithelial neoplasia and cervical carcinoma by microsatellite analysis of Papanicolaou smears.

Carcinoma of the uterine cervix is one of the most common malignancies worldwide, yet it is clearly preventable by population screening. The Papanicolaou (Pap) smear has proved to be the most successful test for the detection of precancerous lesions and is largely responsible for the reduction of cervical cancer mortality and morbidity rates. However, the Pap smear is not perfect; false-negative results of various rates are reported. To improve the diagnostic efficacy of cervical cytology, we performed microsatellite analysis on paired Pap smear samples from cervical lesions. Nine microsatellite markers were chosen from chromosomal regions commonly displaying loss of heterozygostity (LOH) in cervical cancer and those displaying microsatellite instability (MI) in other squamous cell cancer. Microsatellite alterations were detected in 16/21 (76%) Pap smear DNA samples including 11 of 13 (85%) smears from invasive squamous cell carcinomas (SCCs) and 5 of 8 (63%) from squamous intraepithelial lesions (SILs). Microsatellite alterations detected in the Pap smear DNA were identical to those identified in seven paired primary tumors available for analysis. Moreover, this molecular approach detected genetic alterations in two cases apparently negative by cytologic examination. None (0/25) of the control patients displayed microsatellite alterations in paired Pap smears. Microsatellite analysis of cervical cytologic samples may provide a complementary method to analyze suspicious but not diagnostic cytologic samples further.     

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

Cervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade cervical disease. These risks may vary in different areas across the country. Thus, determining the rate of significant cervical lesion associated with each type of abnormal cervical cytology in each area is of critical importance for designing area-specific management approach. This review was conducted to evaluate the rate of high-grade cervical disease among Thai women with abnormal cervical cytology. A relatively high incidence of underlying significant lesions including invasive disease was demonstrated even in those having only minimal smear abnormality. This baseline information is crucial and must be taken into consideration in management of women with abnormal cytological screening to achieve the goals of comprehensive cervical cancer control in Thailand.     

Knowledge,Attitude and Practice of the Pap Smear as aScreening Procedure Among Nurses in a Tertiary Hospital inNorth Eastern India

Background: Cancer of the uterine cervix is one of the most common cancers among women worldwide.Industrialized countries have dramatically reduced the incidence of mortality from cervical carcinoma in the last50 years through aggressive screening programs utilizing pelvic examinations and Papanicolaou (Pap) smearsbut it still remains a major problem in the developing world. Objectives: This study was performed to determineknowledge, attitude and practice of Pap smear as a screening procedure among nurses in a tertiary hospitalin north eastern India. Material and Methods: This cross sectional study was carried out with a questionnairesurvey covering the socio demographic factors, knowledge, attitude and practices about Pap smear screeningamong 224 nurses in Regional Institute of Medical Sciences, Imphal, Manipur, India during December 2011.Results: Two hundred and twenty one participants (98.6%) had heard about cervical carcinoma but 18.3%lacked adequate knowledge regarding risk factors. Knowledge about the Pap smear was adequate in 88.8% ofthe respondents. Out of these, only 11.6% had Pap smear at least once previously. The most common reasons fornon-participation in screening were lack of any symptoms (58.4%), lack of counselling (42.8%), physician doesnot request (29.9%) and fear of vaginal examination (20.5%). Conclusion: Although knowledge of Pap smear asa screening procedure for cervical cancer is high, practice is still low. The nurses who should be responsible foropportunistic screening of women they care for are not keen on getting screened themselves. If we can improvethe practice of Pap smear screening in such experts, they should be able to readily provide appropriate andaccurate information and motivate the general population to join screening programs.     

Opportunistic Screening for Cervical Cancer in a Tertiary Hospital in Karnataka,India

The incidence and mortality of cervical cancer remains high in India even after sixty years of introductionof the Pap smear (cervical cytology) which is an effective means of identifying preinvasive lesions of carcinomacervix. The morbidity and mortality due to cervical cancer has come down drastically in countries with wellestablished screening programmes at national level. This study aims at screening women for cervical canceropportunistically during their visit to hospital and to study various types of neoplastic and non-neoplastic lesionsof the cervix by cervical smear study (Pap smear study). In the present study, a total of 350 cervical smearswere studied. The age of patients ranged from 19 years to 80 years with mean age being 37.5 years. Out of 350cases, the diagnosis of neoplasia was given in 43 cases and 258 cases were diagnosed as inflammatory smears.Forty-cases were normal and 9 cases were inadequate to evaluate. Forty-three patients who were found to haveneoplastic lesions on cytology were referred for further investigations like colposcopy and biopsy to confirm thediagnosis and avail proper treatment. Limitation of the present study was small sample size as all female patientsaged between 20 and 60 years visiting hospital were not included in the screening, other screening tests like VIA(visual inspection with acetic acid test) and HPV DNA (human papilloma virus) tests were not done. Until thetime centrally organised screening programmes for cervical cancer are established in India, arrangements shouldbe made for hospital based opportunistic screening for all women attending hospital. The cost effectiveness ofdifferent screening tests for cervical cancer should be evaluated.     

Awareness of Cervical Cancer and Pap Smear Testing Among Omani Women

Background: In developed countries, awareness of cervical cancer screening is well documented. In contrast, in Oman as a developing country, public responses regarding cervical screening are unclear. This study aimed to assess the level of awareness about cervical cancer and Papanicolau (Pap) smear testing and to establish any correlations between knowledge and demographic factors among Omani women. Methods: In this cross-sectional survey, participants were divided into three groups: patients who attended the Outpatient Gynecology Department in Sultan Qaboos University Hospital (SQUH), Oman, female staff from SQUH, College of Medicine and College of Nursing at Sultan Qaboos University (SQU) and graduating female students at SQU. Data collection was through interview-based and online self-administered questionnaires. Cumulative scoring was used for data analysis. Results: There were 204 outpatients, 133 staff and 157 students. Outpatients (79.4%), staff (97.7%) and students (75.2%) had heard of cervical cancer. Nevertheless, their specific knowledge, regarding signs and symptoms, risk factors and Pap smear, was low at 38.7%, 35.3% and 7.6% among outpatients, staff and students, respectively. Some 39.9% of the married outpatients had adequate overall knowledge as compared to none of the single women. Educational level was found to be significantly associated with outpatient knowledge with the highest awareness levels among postgraduates and medical university graduates (61.5%). Conclusion: Specific knowledge of cervical cancer, its risk factors and cervical Pap smear is generally poor among Omani women. This lack of knowledge may be one of the contributing factors for the high incidence of cervical cancer in Oman relative to that in developed countries.