• Journal of Preventive Medicine and Public Health
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• v.33 no.4
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• pp.505-512
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• 2000

Objective : To estimate the significance of the Pap smear as a screening tool for cervical cancer. Methods : A total of 79,840 Pap smear results peformed at Pusan Paik Hospital over the 20 year period from 1979 to 1998 were collected and analyzed. Results : The number of Pap smear cases increased markedly during this period, and the results as a whole were classified as of 96.4% normal and benign cytology, 2.2% pre-cancerous cytology, and 1.4% cervical cancer. The relative frequency of cervical cancer decreased from 1.6% in 1979 to 0.7% in 1998. About 64% of the Pap smears were distributed within the age range of 30 to 49 years, and the rate of cervical cancer increased with age, age of marriage and experience of childbirth (p<0.01). The overall agreement of Pap smear results with histologic diagnosis by one histologic degree was 92.7%(1,128/1,217) with 73 overestimated cases and 16 underestimated cases of Pap smear compared to histologic diagnosis. Conclusion : This result implies that the Pap smear is an excellent screening tool for cervical cancer with respect to both its scale and validity. Periodic and active Pap smear testing would be helpful for the secondary prevention of cervical cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.14
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• pp.5811-5814
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• 2014

Background: To investigate abnormal cervical histopathology (ACH) from hysterectomy specimens with normal preoperative Papanicolaou (Pap) smears. Materials and Methods: Medical records from May 2009 to April 2012 were retrospectively reviewed of subjects from whom hysterectomy specimens were taken in Thammasat University Hospital. All had normal preoperative Pap smears. ACH was the primary outcome. A p-value less than 0.05 was considered significant. A total of 483 subjects with an average age of 50.5 years were recruited. Benign cases of enlarged uterus and pelvic mass were present in 94% (430/483). Endometrial and ovarian cancer were found at 6.2 and 4.7%, respectively. In hysterectomy specimens there were 19 (4%) cases of ACH. Silent ACH with benign disease, endometrial and ovarian cancers were 1.2% (5/430), 33.3% (10/30) and 17.4% (4/23), respectively. The negative predictive value (NPV) and false negative rate of Pap smears were 96 and 4%, respectively. ACH in malignant cases were 27.9% (12/43) and 20% (2/10) in adequate (APS) and inadequate (IPS) Pap collection groups, respectively. ACH in benign condition were 0.68% (2/292) and 2.2% (3/138) in APS and IPS, respectively. ACH was more often found in hysterectomy specimens with indication of malignancy than benign conditions with statistical significance. One third of preoperative stage I endometrial cancer cases had cervical involvement. Conclusions: Silent ACH in normal preoperative Pap smear was 4 %. Inadequate Pap smear collection is still the major problem in this study. Reducing inadequate Pap smear collection could reduce the false negative rate.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.9
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• pp.5503-5506
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• 2013

This cross-sectional analytic study aimed to investigate any relationship between the body mass index (BMI) and an abnormal Pap smear. The subjects were 7,720 women aged 30-69 years who lived in Khon Kaen Province, Thailand, and had been recruited as participants in the Khon Kaen Cohort Study during 1990-2001. All had received Pap smear screening for cervical cancer. The data were analyzed using descriptive and inferential statistics. Multiple logistic regression was used to determine the relationship between body mass index and an abnormal Pap smear. The mean BMI was $24.53kg/m^2$ (SD=3.98), and 2.14% had abnormal Pap smears. Compared with the reference group of women with a BMI ${\leq}22.9kg/m^2$, those with a body mass index of $23.0-24.9kg/m^2$ had a reduced risk of an abnormal smear (ORadj=0.92, 95%CI: 0.57-1.47), but women with a BMI $25.0-29.9kg/m^2$ were found to have an approximately 1.24 times higher risk ($OR_{adj}=1.24$, 95%CI: 0.86-1.80), and those with a BMI ${\geq}30.0kg/m^2$ had an approximately 1.63 times higher risk ($OR_{adj}=1.63$, 95%CI: 0.98-2.69). The results indicated that the risk of Pap smear abnormalities is increased in women who have a higher than normal body mass index, but this finding was not statistically significant. Nevertheless, public health personnel should encourage women to maintain their BMI in the normal range to reduce the possible future risk of cervical cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.5901-5904
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• 2013

Objective: To compare the effectiveness of different methods of recall for repeat Pap smear among women who had normal smears in the previous screening. Design: Prospective randomized controlled study. Setting: All community clinics in Klang under the Ministry of Health Malaysia. Participants: Women of Klang who attended cervical screening and had a normal Pap smear in the previous year, and were due for a repeat smear were recruited and randomly assigned to four different methods of recall for repeat smear. Intervention: The recall methods given to the women to remind them for a repeat smear were either by postal letter, registered letter, short message by phone (SMS) or phone call. Main Outcome Measures: Number and percentage of women who responded to the recall within 8 weeks after they had received the recall, irrespective whether they had Pap test conducted. Also the numbers of women in each recall method that came for repeat Pap smear. Results: The rates of recall messages reaching the women when using letter, registered letter, SMS and phone calls were 79%, 87%, 66% and 68%, respectively. However, the positive responses to recall by letter, registered letter, phone messages and telephone call were 23.9%, 23.0%, 32.9% and 50.9%, respectively (p<0.05). Furthermore, more women who received recall by phone call had been screened (p<0.05) compared to those who received recall by postal letter (OR=2.38, CI=1.56-3.62). Conclusion: Both the usual way of sending letters and registered letters had higher chances of reaching patients compared to using phone either for sending messages or calling. The response to the recall method and uptake of repeat smear, however, were highest via phone call, indicating the importance of direct communication.

• The Korean Journal of Cytopathology
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• v.4 no.2
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• pp.93-99
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• 1993

The cytologic detection of endometrial carcinoma in Papanicolaou(Pap) smear according to histologic type, grade and stage was studied in 49 patients. The smears of patients who had histologically confirmed were retrospectively evaluated by the Bethesda System. The cytologic diagnosis of endometrial carcinoma was made in 61% (39/49) of patients, atypical glandular cells of undetermined significance (AGCUS) in 16% (8/49) and within normal limits in 23% (11/49). The positive rate for AGCUS and carcinoma was correlated to the histologic type, grade and stage. The cytologic grade revealed a good correlation with histologic grade, too. In conclusion, the presence of cancer cells in Pap smear suggests the tumor in high grade and high stage. Additionally, cytologic detection of AGCUS or carcinoma needs a further diagnostic evaluation. The Pap smear is a valuable method to screen for endometrial carcinoma.

• Journal of Korea Association of Health Promotion
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• v.4 no.1
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• pp.75-84
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• 2006

Background : Osteoporosis and atrophic cell pattern in Pap smear are frequent findings In postmenopausal women due to loss of ovarian function, The present study attempted to find out possible correlation between morphologic characteristics of Pap smear and osteoporosis. Material & methods: The subjects were 825 women(age from 35 to 80) who had undergone Pap smear and bone mineral density(BMD) at The Korea Association of Health Promotion, Seoul Branch, from March 8 to May 10, 2005. Pap smears from 825 women were reviewed and classified either mature cell pattern or atrophic cell pattern by their cytologic patterns, BMD were measured using LUNAR DPX MdIQ(Minster, Ohio, USA). BMD value of lumbar spine(Ll, L2,L3 and L4) were measured from 825 women and BMD value of proximal region off emur(neck NK, Wards triangle WT, and trochanter TR) were measured from 818 women and their bone status were classified as normal( T-sore:>-1.0), osteopenia (T-score: -l~<-2,5) and osteoporosis(T-score: ≤ -2.5). And age distribution of Pap smear, average T-value andfrequency ofsteoporo-sis of each region of the bone, percentage of osteoporosis of each boneregion by age group and changing pattern of percentage of osteopenia and osteoporosis in certain postmenopausal period were compared between mature and atrophic cell pattern. Results: Pap smears revealed total mature cell pattern 53,9%(445/825) and total atrophic cell pattern 46.1%(380/825), Percentage of mature cell pattern decreased from 98.2%(168/171)under 44 age group to 13,3%(17/128) over 65 age group and mature cell pattern increased from 1.8%(3/171) under 44 age group to 86.7%(111/128) oyer 65 age group. Mean T-value of each region of lumbar spine and femur of mature cell pattern were lower than that of atrophic cell pattern about -1,5. And osteoporosis has noted in atrophic cell pattern showing odds ratio Ll 13.9, L2 15.3, L3 12.0, L4 10,4, UK 6.7, WT 10.9 and TR 4.1.Atrophic cell pattern started to increase after 45 years of age and osteoporosis of a trophic cell pattern started after 55 years of age. During 50 to 64 years of age period, L3, L4 and WT revealed parallel increased of osteopenia and osteoporosis and Ll, L2 revealed decreased of osteopenia and increased of osteoporosis. nia Conclusion: Above findings suggest that atrophic cell pattern of Pap smear precedes osteoporosis about 10 years and one of predictor of osteoporosis.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.12
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• pp.6497-6500
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• 2012

Cervical cancer is the second most common cancer in females in the World with around 500,000 new cases occurring annually, but the first in the developing countries with a high mortality if not diagnosed early. Papanicolau (Pap) smear is a cheap, easy-to-apply and widely accepted test which has been long used to detect cervical cancer at very early stages. However, despite being available for nearly 60 years, the test can hardly be considered to have become successfully applied in many communities. We aimed in this study to present the results of a screening survey for cervical cancer which targeted a women population aged between 35 and 40 living in a semi-rural area in the province of Hatay, located in the eastern Mediterranean region of Turkey, with specific aims of increasing early diagnosis, education and raising population awareness about cancers. This community-based descriptive study covered 512 women between 35 and 40 years of age living at Armutlu with a mean age of $37.6{\pm}1.7$. Gynecologic examinations revealed cervical erosion in 8 (1.6%), vaginitis in 193 (37.7%) and normal findings in 311 (60.7%); pathological evaluation reports of the smears were negative in 290 (56.6%), inflammation in 218 (42.6%) and ASC-US in 4 (0.8%), according to the 2001 Bethesda classification. It can be concluded that Pap smear test - proven to be a very valuable test at the clinical level- should also be widely used at the community level to detect cervical cancer at very early stages to reduce both the mortality and morbidity among healthy people. The need for continuous community-based cervical cancer screening programs is strongly suggested.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.2
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• pp.905-910
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• 2014

Aims: To determine the status of women's perception and attitudes about cervical cancer and their thoughts on Kato's self-sampling device. Materials and Methods: This descriptive research was conducted between July-December 2012 with a study populationof married women older than 18 years. Results: A total of 246 women volunteered, with a mean age of $34.9{\pm}9.22$ (19-52). In the last year, 52.0% had been examined by a gynecologist to address a complaint or for a periodic health check. Of the 118 who had not had a gynecological examination, 42.4% indicated negligence, 26.3% stated the reason was no complaint, 14.4% feared they might receive bad results from the examination, and 8.5% stated that were shy or embarrassed. Of all of the women, 35.0% answered that they had information about cervical cancer, and 0.7% had heard about the HPV vaccine. No one in their families had received the vaccine. Of the women, 28.5% had had a Pap smear, and 71.4% of those had normal results. Of those who had never had a Pap smear, 47.2% had never heard about the test; 18.8% explained the reason for not having a test as shyness or embarrassment with a male doctor. None of the women had heard about Kato's device. Once the women were informed, 73.6% expresseed interest in use; 51.9% answered they could use it and not be embarrassed, 30.9% would use it because they did not have to see a doctor, and 17.1% would use it as it allows them to take a smear in all conditions and whenever they want. Of the women, 60.0% thought that they could not successfully use Kato's device; 40.0% thought that a smear should be taken by a doctor. Conclusions: Most of the women in our population had never had a Pap smear and wanted to use the Kato's device.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.5
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• pp.2245-2249
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• 2014

Background: Human papillomavirus is a well-established cause of the development of a variety of epithelial lesions in the cervix. However, as yet, incorporation of HPV testing into cervical cancer screening either as an adjunct or stand alone test is limited due to its cost. We therefore here ascertained the presence and type specificity of human papilloma virus (HPV) DNA in routine cervical scrapings. Materials and Methods: Cervical scrapings were collected from women attending clinics for routine Pap smear screening. HPV-DNA was detected by PCR using MY09/11 and GP5+/GP6+ primer sets and genotyping was accomplished by cycle-sequencing. Results: A total of 635 women were recruited into the study with $mean{\pm}SD$ age of $43{\pm}10.5$ years. Of these 92.6% (588/635) were reported as within normal limits (WNL) on cytology. The presence of HPV infection detected by nested MY/GP+-PCR was 4.4% (28/635). The overall prevalence of high-risk HPV (HR-HPV) in abnormal Pap smears was 53.8% (7/13). HPVs were also seen in 3.1% (18/588) of smears reported as WNL by cytology and 5.9% (2/34) in smears unsatisfactory for evaluation. Conclusions: The overall percentage of HPV positivity in routine cervical screening samples is comparable with abnormal findings in cytology. Conventional Pap smear 'missed' a few samples. Since HPV testing is expensive, our results may provide valuable information for strategising implementation of effective cervical cancer screening in a country with limited resources like Malaysia. If Pap smear coverage could be improved, HPV testing could be used as an adjunct method on cases with ambiguous diagnoses.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.9
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• pp.5101-5105
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• 2013

The incidence and mortality of cervical cancer remains high in India even after sixty years of introduction of the Pap smear (cervical cytology) which is an effective means of identifying preinvasive lesions of carcinoma cervix. The morbidity and mortality due to cervical cancer has come down drastically in countries with well established screening programmes at national level. This study aims at screening women for cervical cancer opportunistically during their visit to hospital and to study various types of neoplastic and non-neoplastic lesions of the cervix by cervical smear study (Pap smear study). In the present study, a total of 350 cervical smears were studied. The age of patients ranged from 19 years to 80 years with mean age being 37.5 years. Out of 350 cases, 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 have neoplastic lesions on cytology were referred for further investigations like colposcopy and biopsy to confirm the diagnosis and avail proper treatment. Limitation of the present study was small sample size as all female patients aged 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 the time centrally organised screening programmes for cervical cancer are established in India, arrangements should be made for hospital based opportunistic screening for all women attending hospital. The cost effectiveness of different screening tests for cervical cancer should be evaluated.