Prevalence and characteristics of abnormal Papanicolaou smear in Central Saudi Arabia

Objectives:

To assess the prevalence and characteristics of abnormal pap smear in the central region of Saudi Arabia.

Methods:

In this retrospective case control study conducted in the Departments of Obstetrics and Gynecology, and Histopathology at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, all pap smears screened for Saudi women between 2008 and 2011 were reviewed. Approximately 5000 pap smears are screened annually at King Abdulaziz Medical City utilizing the Bethesda III System (2001). All abnormal smears patients’ data were collected and compared to the data of randomly selected 200 normal smears’ patients.

Results:

Abnormal pap smear prevalence was found to be 4.3% (841/19,650 Saudi patients were found with atypical epithelial cells abnormalities). Its prevalence in the years 2008 was 5.7%, 2009 was 4.9%, 2010 was 4.2%, and 2011 was 2.5%. Abnormal smear patients have lower parity (p=0.001), and were less likely to use intra-uterine devices (p=0.03) compared with normal smear patients. Presence of abnormal cervical appearance was associated with increased epithelial cell abnormalities (p=0.045). The only positive history that has characterized patients with epithelial cell abnormalities was their previous history of abnormal pap smear (p=0.001). Squamous cell abnormalities were identified in 91% of the patients (767/841), and glandular cell abnormalities were identified in 9% of the patients (74/841).

Conclusion:

Prevalence of abnormal pap smears in central Saudi Arabia is relatively low, while advanced glandular abnormalities prevalence was observed to be high.Cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (CC) are documented to be less common in Saudi Arabian women community, as compared with some western communities.1-4 This observation was based on studies carried out in Al Baha in the southern region, and Jeddah in the western region of the Kingdom of Saudi Arabia (KSA). No similar recent study was performed in the central region of KSA that allows a clear view on the prevalence of the disease and its characteristics. It is important to mention here that up-to-date, CC screening program has not been implemented in KSA, and pap smear screening is still performed on an opportunistic basis. Moreover, CIN is known to be related to high risk human papilloma virus (HPV) infections, in particular HPV types 16 and 18.5,6 These particular infections are proven to be preventable by available tested vaccines.6 However, there is not enough published data on the prevalence of HPV and its genotypes in KSA that justify cervical cancer preventive vaccination program. Over the last few decades, the financial status of the Saudi population has improved,7 resulting in change in lifestyle, higher mean female age, and more expatriates are mixing with the Saudi population.8 We believe that the prevalence of abnormal pap smear in KSA might be increasing. National alertness and governmental work for preventive program implementation might be an urgent requirement. Such preventive program may assist in early detection and mortality/morbidity reduction of CC.9,10 In this research, we aimed to report an assessment of the prevalence of abnormal pap smears in the central region of KSA, smears cytology findings, and the clinical and personal characteristics of patients who were diagnosed with abnormal pap smears.