1. PAP SMEAR FINDINGS AMONG WOMEN SCREENED FOR CERVICAL CANCER AT THE NATIONAL OBSTETRIC FISTULA CENTRE, ABAKALIKI, SOUTH-EAST, NIGERIA BY Dr OKENWA SAMUEL CHIMA

2. AUTHORS Ekwedigwe K.C, Daniyan ABC, Sunday-Adeoye I, Mbamalu S.O, Okenwa S.C, Iyare F

3. OUTLINE Introduction Methodology Result Discussion Conclusion Recommendation

4. ABSTRACT BACKGROUNG: Pap smear also known as Pap test is a procedure used to screen for cervical cancer which is the most common gynaecological cancer in women. OBJECTIVE: The study reviews findings among women screened for cervical cancer at the National Obstetric Fistula Centre with the aim of determining those with the premalignant phase. METHOD: This is a cross sectional retrospective study. The case records of 316 patients who had undergone cervical screening between August 2012 and March 2013 were reviewed for biological, social and cytology findings. Analysis of data was done using SPSS statistics version 21. RESULTS: Majority (33.5%) of patients screened were within ages 30 – 39years, significantly (75.3%) married women presented for screening, most (57.6%) of the patients were civil servants. Vaginal examination did show 87.7%had normal findings and 2.5% had abnormal bleeding. 66.5% were negative on visual inspection by acetic acid and the Pap smear results showed 50% of patients had normal findings and 26.6% had inflammatory cells on cytology. Only 0.6% showed dysplasia on pap smear. CONCLUSION: The study showed a high awareness among married women and majority of women had normal Pap smear findings. KEYWORD: PAP SMEAR, CERVICAL CANCER.

5. INTRODUCTION Cervical cancer is the most common gynaecological cancer only second to breast cancer in women 1 The incidence of cervical cancer in Nigeria is 250/100000 per year 2 This condition is largely preventable by effective screening programmes 3 Pap smear is a screening test for cervical cancer The test was invented by and named after a Greek doctor George Papanicolaou in 1928 4 Pap smear is regarded to be very specific but only moderately sensitive 5

6. METHODOLOGY This study was done at the National Obstetric Fistula Centre, Abakaliki, South-East, Nigeria from August 2012 to March 2013 Study Population: Women who have attained reproductive age status Study Design: A retrospective study Sample size A total of 316 women entered for this study, women who had presented for cervical cancer screening The biological, social and cytological findings of these women screened were documented for the basis of this study

7. Sampling Technique: Convenient sampling method was used and analysis was done using SPSS vs. 21 Inclusion Criteria: Women who have attained reproductive age and have commenced sexual activities Exclusion Criteria: * Women who are menstruating * Women with obvious cervical lesions Limitation of Study: Visual inspection by Lugol’s iodine was not done

8. n=316% Age <2030.9 20-293711.7 30-3910633.5 40-499630.4 50-595718 >59175.4 Parity 03410.8 1196 2-46420.3 >419963 Marital status SINGLE175.4 MARRIED23875.3 DIVORCED/SEPARATED20.6 WIDOW5818.4 Occupation FARMING18257.6 TRADER4714.9 STUDENT123.8 CIVIL SERVANT4714.9 NONE113.5 ARTISAN175.4 SOCIODEMOGRAPHIC VARIABLES

9. VAGINAL EXAMINATION FrequencyPercent NORMAL27787.7 BLEEDING82.5 LESION206.3 IUCD THREAD2.6 DISCHARGE92.8 Total316100.0 VIA FrequencyPercent POSITIVE10633.5 NEGATIVE21066.5 Total316100.0

10. PAP SMEAR RESULT FrequencyPercent NORMAL FINDINGS15850.0 INFLAMMATORY8426.6 UNSACTISFACTORY7222.8 DYSPLASIA2.6 Total316100.0

11. PAP SMEAR RESULTTotal NORMAL FINDINGSINFLAMMATORYUNSACTISFACTORYDYSPLASIA VIA POSITIVE5331220106 NEGATIVE10553502210 Total15884722316 P>0.05 Relationship Between Pap Smear findings and VIA

12. RESULT Majority (33.5%) of patients screened were within ages 30 – 39 years, with a mean age of 40.7 + 10.7years. Most patients were Para 4 and above Significantly (75.3%) married women presented for screening, of which most (57.6%) were civil servants Vaginal examination did show 87.7% had normal findings and 2.5% had abnormal bleeding On visual inspection by acetic (VIA) acid 66.5% were negative

13. RESULTS contd Pap smear results showed 50% of patients had normal findings and 26.6% had inflammatory cells Only 0.6% showed dysplasia on pap smear There is no statistical significant difference between Pap smear findings and VIA findings

14. DISCUSSION From the result, majority were above the age of 30 years, this result is similar to studies FETHA Abakaliki 6 but varies with a study done in Nnewi where majority of the respondents where between ages 25 – 29years 7 Most of the women were married, this is in keeping with similar studies done in South-East Nigeria 7 and North Central Nigeria 8 A significant number of patients screened 87.7% had normal findings on vaginal examination

15. DISCUSSION contd On visual inspection by acetic acid, majority of the patients screened tested negative, this result is similar to a study done in India 9 but varies with a study done in Khartoum, Sudan 10 Results from pap smear taken from screened patients showed 50% of patients had normal findings and only 0.6% showed dysplasia; this is similar to previous study done in Turkey 10 and India 12 Only 2 (0.6%) of the patients screened showed dysplasia on pap smear and these 2 were VIA negative. However, there is no statistical significance difference between Pap smear finding and VIA findings on cervical screening.

16. CONCLUSION This study showed a high awareness cervical cancer screening among married women and majority of the women had normal Pap smear finding This study also showed that VIA had sensitivity comparable to Pap Smear

17. RECOMMENDATION For complete cervical cancer screening; VIA, Visual inspection with Lugol’s iodine(VILI) and Pap Smear Should be employed However, in low resource settings VIA alone can be used as a screening tool

18. References 1. Mahmood IS. Premalignant and malignant disease of the cervix. Dewhurts Gynaecological Obstetrics. 7 th Ed; 2007;614 2. Pisani P, Parkin DM, Bray F, Ferley J. Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer 1999;83:870-3 3. Maheck et al., 1994; Yaren et al., 2008 4. Palatianos GM, Cintron JR, Narula T. George N. Papanicolaou, MD. Father of modern cytology. A 30-year commemorative. J Fla Med Assoc. 1992;79:837-838. 5. Cervical Screening Presentations; For Providers of Medical Practioner Education in Queensland; 20:10:2014 6. Chinaka CC, Udeajah VN. Awareness of cervical cancer screening among women visisting Federal Teaching Hospital Abakalik, Nigeria. Journal of App Med Sci. 4; 2012: 47 - 66 7. Obafunwa et al., 1999; Apgar et al., 2001; Sharp et al., 1987 8. Oche MO, Kaoje AU, Gana G, Ango JT. Int J of Med and Med Sci; 5(4); 2013;184-190 9. Bhavana S, Anita D, Geeta D, Yeshita P, Hema D. Cervical Cancer Screening by Visual Inspection with Acetic Acid – Interobserver Variability between Nurses and Physicians, Asian Pacific JCancer Prevention. 11;2010;619-622 10. Ahmed I, Vibeke R, Eero P, Arja RA. Cervical cancer risk factor and feasibility of visual inspection with acetic acid screening in sudan 11. Ayten D. Pap screening result for Turkish pregnant women. Asian Pacific J Cancer Prevention. 13(11) 2012;5835-5838 12. Mandakini MP, Amrish NP, Jigna M. Cervical Pap Smear and its utility in Cancer Screening, to specify the Strategy for Cervical Cancer Control. National J Comm Med. 2011;2;1

19. THANK YOU.