Effective cervical cytology screening programmes in middle-income countries: the Chilean experience

OBJECTIVE: To demonstrate that an effective cervical cancer screening programme based on the Papanicolaou (Pap) smear can be organized in a middle-income country, such as Chile. METHODS: The cervical cytology screening programme in Chile is evaluated by comparing process measures and cervical cancer mortality before and after its reorganization in 1987. FINDINGS: Two decades of opportunistic annual screening for cervical cancer from the mid-1960s to the mid-1980s did not reduce cervical cancer mortality in Chile. In 1987, a public health oriented program was launched, based on screening women aged 25-64 every 3 years, rather than the annual screening of low risk women attending family planning clinics that gathered mainly women less than 25 years of age. The reoriented program emphasized the optimization of existing resources, the timeliness of diagnosis and treatment, reliability of the Pap smear and low cost screening promotion strategies at the community level. More than 80% of women with abnormal Pap smears received prompt medical attention and 100% of the public laboratories were subject to external quality control. According to biannual national surveys, coverage by Pap smear screening in the target group rose from 40% in 1990 to 66% in 1996. The age adjusted cervical cancer mortality rate decreased from 12.8 in 1980 to 6.8 per 100,000 women in 2001. CONCLUSIONS: Improved organization of the national cervical cancer screening programme in Chile and more efficient use of existing resources resulted in a decrease of cervical cancer mortality.     

The Coverage of Cervical Cancer Screening in Khon Kaen,Northeast

Cervical cancer is a common cancer in Thai women and one of the only cancers that can be readily cured if early ‍detection is successful. The Pap smear is an accepted as an appropriate means for cervical cancer screening at ‍present. However, there are still some management problems with early detection programmes. Since data showing ‍how many women have been screened by Pap smear are limited in Thailand, the present study was conducted with ‍the aim of determining coverage in a defined population in the sample area, Thakaserm sub- district in Nampong ‍district, Khon Kaen province, Thailand. The investigation was carried out during June-August 2000 to collect ‍information on history of screening for cervical cancer using questionnaires. All women aged 20 and above were ‍asked to answer the set of questionnaires a total of 1,199 women responded. There were 66.9% that reported having ‍received a Pap smear test for screening for cervical cancer at least once. However, there were 33.1 % that had never ‍undergone a Pap smear in their life. It is important to find a strategy to increase the coverage of cervical cancer ‍screening programme for this population. ‍     

Cervical cancer in Latin America

Cervical cancer is a common cause of morbidity and mortality in developing countries. In Latin America, the incidence rates in several cities are among the highest worldwide, probably due to a high frequency of risk factors and/or a low screening coverage for cervical cancer. Epidemiologic studies conducted in Latin America (and some in the Caribbean), that have investigated the main risk factors for the disease, as well as screening coverage by Papanicolaou (Pap) smear, were reviewed. The prevalence of human papillomavirus (HPV) infection among women with negative Pap smears does not seem to explain the risk observed in Latin American countries. Results of some studies have suggested that reproductive factors and male sexual behavior might be responsible, at least partially, for the high occurrence of cervical cancer in Latin America. Concerning cytology screening, many women have a smear taken regularly (some every year). However, a significant proportion of women, probably those with a high risk of cancer of the cervix, have never had a Pap test. To reduce cervical cancer in these countries, screening programs in Latin America should have a wider coverage, especially reaching those women at higher risk. Semin Oncol 28:188-197.     

Decreasing cervical cancer mortality in Mexico: effect of Papanicolaou coverage, birthrate, and the importance of diagnostic validity of cytology

BACKGROUND: The reduction in cervical cancer mortality in developed countries has been attributed to well-organized, population-based prevention and control programs that incorporate screening with the Papanicolaou (Pap) smear. In Mexico, there has been a decrease in cervical cancer mortality, but it is unclear what factors have prompted this reduction. METHODS: Using data from national indicators, we determined the correlation between cervical cancer mortality rates and Pap coverage, birthrate, and gross national product, using a linear regression model. We determined relative risk of dying of cervical cancer according to place of residence (rural/urban, region) using a Poisson model. We also estimated Pap smear coverage using national survey data and evaluated the validity and reproducibility of Pap smear diagnosis. RESULTS: An increase in Pap coverage (beta= -0.069) and a decrease in birthrate (beta=0.054) correlate with decreasing cervical cancer mortality in Mexico. Self-reported Pap smear rates in the last 12 months vary from 27.4% to 48.1%. Women who live in the central (relative risk, 1.04) and especially the southern (relative risk, 1.47) parts of Mexico have a greater relative risk of dying of cervical cancer than those who live in the north. There is a high incidence of false negatives in cervical cytology laboratories in Mexico; the percentage of false negatives varies from 3.33% to 53.13%. CONCLUSIONS: The decrease in cervical cancer mortality observed in Mexico is proportional to increasing Pap coverage and decreasing birthrate. Accreditation of cervical cytology laboratories is needed to improve diagnostic precision.     

Probability of early repeat Pap smear in an integrated cervical screening programme.

The integration of routine Pap smear practice based on self-referral into an organized programme based on personal invitation is the recommended approach to cervical cancer screening. In this study, the cytology archive of the integrated cervical screening programme implemented in the Faenza district (northern Italy) was used to compare the population of women responding to invitation with that of self-referred women for the cumulative probability of early (< 36 months) repeat Pap smear after a negative result. Between 1995 and 1998, women aged 25-64 living in five municipalities of the district were targeted by the first round of the programme. Eligible for the study were 2356 women responding to invitation for screening and 2221 women not invited because of self-referral for Pap smear at any other setting. The probability of early repeat Pap smear was estimated by the life table method. Differences were evaluated by the Gehan test. Multivariate determinants were assessed by the Cox regression analysis. At 36 months' follow-up, the cumulative probability of early repeat Pap smear was 44% among self-referred women and 6% among women responding to invitation (relative hazard = 4.8). For self-referred women, the probability was related to age (with a peak at 35-44 years), previous Pap smear history and municipality of residence. Among women responding to invitation, only an inverse association with age was demonstrated. In conclusion, the observed differences in overall probability and determinants of early repeat Pap smear between the two screening populations provided important information on Pap smear usage in the total target population.     

A comparison of liquid-based cytology and Pap smear as a screening method for cervical cancer

The implementation of population-based screening for cervical cancer with Pap smear in the early sixties was set to detect and treat precancerous lesions, hopefully preventing a subsequent invasive cervical cancer. Epidemiological data indicate that organized screening has a major impact on morbidity and mortality from cervical cancer. The limited sensitivity of a single smear necessitates repeated smears in organized program. It is suggested that liquid-based cytology improves the sensitivity. The aim of this split-sample study was to compare ThinPrep liquid-based cytology with conventional Pap smear, relying on a laboratory with long-term experience of the latter. In total, 137 women with atypical Pap smear in population-based cervical screening were enrolled for the split-sample study. The performance of both techniques (ThinPrep liquid-based cytology and conventional Pap smear) were compared and validated by a histological follow-up. Women without representative histological biopsy were excluded from the study. Pap smear had sensitivity for detection of CIN2-3 of 47% compared to 66% for liquid-based material. The concordance of the two sampling techniques with the histological diagnosis was 37% and 53%, respectively, this difference being statistically significant. The proportion of reports on atypical squamous cells of undetermined significance (ASCUS) was significantly less in the liquid-based material, 4.3% compared to 8% of the conventional smears. This improved sensitivity in combination with the possibility to perform reflex testing such as HPV DNA or p16 immunocytochemistry without renewed sampling gives ThinPrep a substantial advantage and makes the liquid-based technique interesting.     

Prevalence and Risk Assessment of Cervical Cancer Screening by Papanicolaou Smear and Visual Inspection with Acetic acid of Pregnant Women at a Thai Provincial Hospital

Background Cervical cancer is the second most common in Thailand, but the mortality rate may be rising yearly. It is a cancer that can be prevented by early screening for precancerous lesions, several methods being available. Objective To identify the prevalence of abnormal Papanicolaou (Pap) smears and lesions with visual inspection with acetic acid (VIA) in pregnant women and assess risk factors for this group. Materials and Methods This prospective study was performed at Prapokklao Hospital, Thailand during April-July 2016. All pregnant women of gestational age between 12-36 weeks who attended antenatal clinic were recruited. All participants were screened for cervical cancer by Pap smear and VIA. If results of one or both were abnormal, colposcopic examination was evaluated by gynecologic oncologist. Results A total of 414 pregnant women were recruited. Prevalence of abnormal Pap smear and VIA were 6.0 and 6.7 percent, respectively. The most common abnormal Pap smear was low grade intraepithelial lesion (LSIL, 44%). Factor associated with abnormal Pap smear in pregnant women were low BMI, multiple partners and government officer. In pregnancy, Pap smear had higher sensitivity and specificity than VIA for detection of precancerous cervical lesion. Patients with young coitarche or more than 25 years of active sexual activity were high risk groups. Conclusions Prevalence of abnormal Pap smear and VIA in pregnant women was 6.0 and 6.7 percent, respectively. Factors associated with abnormal Pap smear were coitarche, years of sexual activity, low BMI, multiple partners and government officer.     

Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan

BACKGROUND: Despite the widespread use of Papanicolaou (Pap) smear screening, substantial morbidity and mortality from cervical carcinoma continue in the U.S. Although access to screening is a major barrier to use of the Pap smear, invasive cervical carcinoma (ICC) still is observed in health plan members who have comprehensive preventive care coverage. METHODS: For all women diagnosed with ICC between 1988 and 1994 in a large prepaid health plan, the authors retrospectively reviewed the medical records for prediagnosis Pap smear history to identify antecedents to ICC. RESULTS: Of 642 women diagnosed as having ICC, 455 (71%) had been plan members for > or = 30 of the 36 months before diagnosis. Of these 455 women, 240 (53%) had no Pap smear during the 6-36 months prior to diagnosis (i.e., were nonadherent to screening), 127 (28%) had only "normal" Pap smear results, 42 (9%) had at least 1 abnormal Pap smear and were adequately followed, 17 (4%) had at least 1 abnormal result without adequate follow-up, and 29 (6%) were classified as "other." Compared with adherent women, more nonadherent women presented with later stage disease, were symptomatic at the time of diagnosis, were older, and were of a race/ethnicity other than non-Hispanic white. CONCLUSIONS: Nonadherence to screening recommendations was found to be the most important modifiable antecedent to ICC in this population. The rate of incidence of ICC could be reduced by interventions to increase screening in women who do not have Pap smears regularly and by the use of newer screening technologies to reduce the false-negative rate of Pap smears.     

Limited Understanding of Pap Smear Testing among Women,a Barrier to Cervical Cancer Screening in the United Arab Emirates

Global data indicate that cervical cancer is the fourth most common cancer among women worldwide. Important factors that affect interventions for early diagnosis of cervical cancer include social beliefs and values and poor knowledge. These may contribute to women’s participation in screening for cervical cancer and have a significant impact on decisions to take preventive action. The present study was conducted with 599 women in the UAE between September 2016 and March 2017. A cross-sectional survey was conducted to determine knowledge about cervical cancer and screening, demographic characteristics and perceived barriers. Knowledge about the Pap smear test was limited, and awareness that they should undergo the Pap smear test every three years even with an initial negative/normal Pap smear result was abysmal. In spite of the positive attitude of the women towards the Pap smear test, almost 80% of the women surveyed had no knowledge of precancerous lesions. Having higher income (21/29, 72%, p=0.027) and more miscarriages were associated with better practice of Pap smears (19/26, 73%, p=0.010). Knowledge levels were significantly higher (66.3±22.2,) that values for attitude (60.5±20.9, p= 0.03, 95% CI {0.22-11.3}, Chi-square 4.38) and practice (53.7 24.1, p= 0.001, 95% CI {6.9-18.1}, Chi-square 19.7). A well-designed health education programme on cervical cancer and benefits of screening should increase the awareness among women in UAE. One point to stress is that better communication with health professionals and improvement of access to health care services should increase the rate of cervical cancer screening.     

Knowledge and practices on breast and cervical cancer screening methods among female health care workers: a Sri Lankan experience

Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but they are largely preventable. There are limited data on knowledge and practices on screening methods of breast and cervical cancers among female health care workers in Sri Lanka, in spite of having an organized screening programme islandwide. A cross-sectional survey was conducted among 219 female health care workers including public health midwives (68.9%) selected from 6 districts in Sri Lanka using convenient sampling methods. A self-administered questionnaire was used as a pre-test in a capacity building training programme to collect the data. The mean (SD) duration of work experience of the respondents was 12 years and 52.5% were aged over 35 years. Most (76.7%) were married, and a family history of cancer was reported by 24.2%. Over 98% knew about self breast examination. Even though 84.1% practiced it, only 47.9% practiced it on a monthly basis. Clinical breast examination and mammography were known by 94.1% and 64.3% respectively. Only 19.2% had undergone a clinical breast examination within one year and 3.6% had ever undergone a mamography. Only 76.3% knew that a Pap smear detects precancerous stage of cervical cancer. Among 169 married workers, 73.4% had never had a Pap smear and only 17.2% had got it done within the preceding 5 years. Among the reasons for not doing a pap smear within 5 years, 47.0% believed it as not necessary, 17.3% due to fear/dislike, 23.2% as not having symptoms, 3% had not known about it and 3% not known about availability of services. The study findings suggest that the knowledge and practices on breast and cervical cancer screening methods among female health care workers need to be improved. Considering the role that health care workers play in communicating health behaviors to the general public, strengthening health education interventions for this group of females is essential.     

English proficiency and physicians' recommendation of Pap smears among Hispanics

BACKGROUND: Hispanics have one of the highest incidence rates of cervical cancer. Physician recommendation is one of the most important cues to cancer screening; however, low English proficiency among Hispanics may hinder health providers' recommendation of Pap smears. METHODS: Analysis of data from the 2000 National Health Interview Survey. All Hispanic women, age > or =18, without a Pap smear in the past 3 years or ever and who visited a health care provider in the past year were included. The main outcome was receipt of Pap smear recommendation by a health care provider. RESULTS: A total of 314 Hispanic women were included in the analysis, 44.9% were highly English proficient. Only 7.7% of low English proficient Hispanics not up-to-date in cancer screening reported a recommendation for a Pap smear as compared to 14.3% of highly proficient Hispanics. After adjusting for sociodemographics and health access and utilization factors, highly English proficient Hispanics were more than two times as likely to report receiving a recommendation for a Pap smear as compared to the less proficient (aOR 2.2, 95% CI 1.1-4.5). CONCLUSIONS: Low English language proficiency is a barrier to receive a recommendation for Pap smear among Hispanic women not up-to-date with cervical cancer screening. Further research is needed to explore specific mechanisms responsible for the low recommendation rates and to assess the impact of interpreters or Spanish-speaking providers on Pap smear recommendation rates.     

Harms of cervical cancer screening in the United States and the Netherlands

We studied harms related to cervical cancer screening and management of screen‐positive women in the United States (US) and the Netherlands. We utilized data from four US integrated health care systems (SEARCH), the US National Health Interview Survey, New Mexico state, the Netherlands national histopathology registry, and included studies on adverse health effects of cervical screening. We compared the number of Papanicolaou (Pap) smear tests, abnormal test results, punch biopsies, treatments, health problems (anxiety, pain, bleeding and discharge) and preterm births associated with excisional treatments. Results were age‐standardized to the 2007 US population. Based on SEARCH, an estimated 36 million Pap tests were performed in 2007 for 91 million US women aged 21–65 years, leading to 2.3 million abnormal Pap tests, 1.5 million punch biopsies, 0.3 million treatments for precancerous lesions, 5 thousand preterm births and over 8 million health problems. Under the Netherlands screening practice, fewer Pap tests (58%), abnormal test results (64%), punch biopsies (75%), treatment procedures (40%), preterm births (60%) and health problems (63%) would have occurred. The SEARCH data did not differ much from other US data for 2007 or from more recent data up to 2013. Thus compared to the less intensive screening practice in the Netherlands, US practice of cervical cancer screening may have resulted in two‐ to threefold higher harms, while the effects on cervical cancer incidence and mortality are similar. The results are also of high relevance in making recommendations for HPV screening. Systematic collection of harms data is needed for monitoring and for better incorporation of harms in making screening recommendations.     

Effect of organized screening on incidence and mortality of cervical cancer in Denmark

Pap smears were used only on a limited scale in Denmark until the late 1960s. Since then smears have been taken both in organized screening programs and outside the programs by general practitioners, private gynecologists, and hospital wards. The present smear-taking activity is equivalent to an average of one smear every second year per woman. As the responsibility for health care rests with the counties in Denmark, differences are found between the counties both concerning organization of screening programs, and concerning the overall level of the smear-taking activity. An analysis using multiplicative Poisson models on county-based incidence and mortality data for women aged 30-59 years in 1963-1982 showed a statistically significant effect of organized screening in reducing both the incidence (RR = 0.67; 95% CI, 0.61-0.73), and the mortality (RR = 0.68; 95% CI, 0.59-0.78) of cervical cancer from 5 years after introduction of an organized screening program. The level of overall smear-taking activity was found to be of limited importance when organized screening was taken into account.     

Enhancement of the Cervical Cancer Screening Program in Malaysia: A Qualitative Study

Introduction: Cervical cancer has long been known as a preventable disease. Yet it still is a prime women’shealth issue globally. In Malaysia, the current cervical cancer screening program, introduced in the 1960s, hasbeen found to be unsuccessful in terms of Pap smear coverage. The aim of this study is to determine providersperceptives on the program and the feasibility of practicing an organized cervical screening program in Malaysia.Methods: 11 key informant interviews were conducted with policy makers and health care providers from theMinistry of Health in Malaysia from October 2009 to May 2010. Interviewees’ perceptions were explored oncurrent and organized cervical screening program based on their expertise and experience. Results: The resultshighlighted that the existing cervical screening program in Malaysia faced flaws at all levels that failed to reducecervical cancer morbidity and mortality. The identified weaknesses were poor acceptance by women, lack ofcommitment by health care providers, nature of the program, an improper follow-up system, limited resourcesand other competing needs. Complementarily, all interviewees perceived an organized cervical screening programas an alternative approach both feasible and acceptable by women and government to practice in Malaysia.Conclusion: Better screening coverage depends on an effective screening program that incorporates a behaviourbasedstrategy. A new program should be focused in the policy-making context to improve screening coverageand to effectively combat cervical cancer.     

National Cervical Cancer Screening in Thailand

Background: Cervical cancer is an important public health problem in Thailand. It was the most common cancer in Thai women with the incidence rate of 23.4 per 100,000 women in 1990. Objective: The aim of this study was to share the experiences and summary the outcome of cervical cancer screening program in Thailand. Methods: The Ministry of Public Health in cooperation with the National Health Security Office, launched the National Cervical Cancer Screening Program, covering 76 provinces nationwide under Universal Coverage Scheme in 2005. The screening method are Pap smear and Visual Inspection with Acetic acid (VIA) for women aged 30-60 and 35-45 respectively with a 5-year screening interval. Detecting cervical pre-cancerous lesions will follow by day care treatment such as cryotherapy, Loop Electrosurgical Excision Procedure, etc. Results: The first phase (2005-2009), was carried out on 3,124,855 women, the coverage reached 77.5%. For the second phase (2010-2014), 7,637,226 women were screened, reaching 53.9% coverage of target women. However, we have few data of follow up examination after abnormal screening. Therefore, we conducted new system to get more follow up data in 2019. Under the coordination of many related partners, 10,762,081 women have been screened during 2005-2014. The incidence rate declined to 11.7 per 100,000 women which is ranked as the third most common in women in 2014. Conclusion: This article briefly reviews the challenge of implementing an efficient cervical cancer screening in Thailand. In 2020, HPV testing has been introduced as a primary screening test for all Thai women attending public health sector instead of conventional Pap test.     

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.     

Epidemiologic report of gynecologic cancer in Thailand

Cancer has been the most common cause of death in Thailand from 2002 (65.4/100,000/year in 2002). With regard to leading cancers in Thailand for female population, the highest incidence falls into cervical cancer (25/100,000/year) followed by breast, liver and bile duct, bronchus and lung, colon and rectum, and ovarian cancer. In 2003, there were 6,243 new cases of cervical cancer with the death of 2,620 women. Therefore, in Thailand, seven women die from cervical cancer each day. However, the incidence of cervical cancer in Thailand is decreasing. The important factor contributed to this decreasing is the implement of Thailand dual-track strategy cervical screening program using both Pap smear and visual inspection with acetic acid (VIA)-cryotherapy. Learning about the epidemiologic data of gynecologic cancer could raise public awareness and play a part in establishing measures for prevention, control and treatment of the cancer which will contribute to the better health of women, and of course, decrease the expense used in various modalities of treatment.     

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.