Screening for Cervical Cancer by Sequential Examination of the Cervix

Abstract

Background: cervical cancer carries a death sentence in the mind of every patient. Since it has a long history; it can be cured if caught early. Pap smear screening has been effective in reducing rates of cervical cancer, still, it has some draws back especially low sensitivity. The study aimed to increase the detection of Pap- tests by sequential examination of the cervix by Pap smear and colposcopy and to demonstrate the demographic criteria of those affected. Material and method: A Comparative clinical study, conducted in the department of Obstetrics and Gynecology in AL-Yarmouk hospital /Baghdad, Iraq from 2017-2018. One hundred sexually active female fits into our inclusion and exclusion criteria were invited to participate after we explain it is aim, all participant filled a questioner sheet and were screened by Pap-smear then immediately by colposcopy exam. Result: history of post-coital bleeding and bleeding on touch scored meaningful P-value<0.05, Pap-smear examination shows 20% as abnormal study stratified into 13/20 CIN I [Cervical Intraepithelial Neoplasm], 3/20 CIN II, 2/20 CIN III, and 2/20 malignant cases. The colposcopy exam showed 32/100 abnormal cases necessitating directed histological biopsies. Examination confirms 20/32 CIN I, 7/32 CIN II, 2/32 CIN III, and 3/32 cases with cervical malignancy. Conclusions: cervical smear had specificity and positive predictive value of 100% yet it missed 11 cases diagnosed with colposcopy one was malignant. As a result, Pap-smear alone can detect up to 18% of the pre-cancerous lesion of the cervix, this figure increases to 29% when dumbing the results of the colposcopic directed biopsy. The sensitivity of the test was 62.5% with a false-negative percentage of 37.5%, having a total 88% accuracy rate and a negative predictive value of 85%, this study confirms the benefits of the combined method of screening and may be used to increase pap-smear sensitivity.