FREQUENCY OF SMEAR POSITIVE PRE-CANCEROUS CERVICAL LESIONS AT A TERTIARY CARE HOSPITAL IN PESHAWAR

ABSTRACT

Background: Cervical cancer is a common malignant tumor worldwide causing death in considerable number of women. It is preceded by a pre-cancerous state, which can be diagnosed by a Papanicolaou (PAP) smear.

Objectives: To determine the frequency of pre-cancerous cervical lesions in out patients of Obstetrics and Gynecology department.

Sampling methods and technique: Convenient sampling method was used.

Settings and Duration: Out Patient Department (OPD) of Obstetrics and Gynecology (Obst. & Gynae) at Postgraduate Medical Institute (PGMI) Hayatabad Medical Complex (HMC), Peshawar from January –December 2009.

Patients and Methods: This was a hospital based cross sectional study where patients presenting with vaginal discharge, postmenopausal bleeding and dysfunctional vaginal bleeding were included. Patients with negative cervical cytology smear in the last 6 months were excluded along with those having contraindications for medical examination and women during menstruation. PAP smear was done in all patients and samples were immediately fixed in 95% ethyl alcohol and sent for staining and cytology.

Results: A total of 450 patients were screened using PAP smear in one year.  Mean age of the patient’s was 33 + 8.5 years (16-60 years) and 45% were between 20-30 years of age. Majority were house wives (94%), multiparous,(80.5%), illiterate (77%) and most were pakhtoons (83.3%).

Abdominal pain was the commonest presenting symptom seen in 256(57%), followed by dysuria in 174(38.7%), vaginal discharge in 334(74.2%), frequent coital bleeding in 49(10.9%), infertility in 54(12%) and sexually transmitted infections in 27(6%). Past history of  surgery was present in 65(14.4%) cases.

Cytology was normal in 321(71.3%) cases while 86(19.1%) had inflammatory changes. Low grade dysplasia was seen in 6(1.4%) cases and none had high grade dysplasia or  carcinoma in situ or invasive cervical cancer. Inadequate smears were seen in 36(8%).

Conclusions: In this small sample study, though no case of cervical cancer was seen but keeping in view the morbidity and mortality with this condition, public education and regular screening of reproductive age women should be done at health care settings.