A Study on Effectiveness of Pap Smear in Mass Screening of Premalignant Lesions of Cervix
Kailash C Kharkwal, Kevin Lo, Afrose Tahmina, Theoann L Daniel, N Teelashinee, Tee C Hing, Naqiuddin BM Fazali
Cervical cancer, Colposcopy, Pap smear screening, Sensitivity, Specificity,Biopsy
Citation Information :
Kharkwal KC, Lo K, Tahmina A, Daniel TL, Teelashinee N, Hing TC, Fazali NB. A Study on Effectiveness of Pap Smear in Mass Screening of Premalignant Lesions of Cervix. 2019; 2 (2):65-68.
Background and objectives: A study on the accuracy of Pap smear was conducted in Pantai Hospital, Sungai Petani, Malaysia involving 125 patients from the Department of Obstetrics and Gynaecology. Cervical cancer is a significant health issue for women; being the second most common cancer among women in Malaysia hence early detection of precancerous lesions can prevent progression to cervical carcinoma. The objective of this study was to measure the sensitivity, specificity, positive predictive value, negative predictive value, percentage of false-negative, percentage of false-positive and yield of Pap smear by comparing Pap smear results with colposcopy guided cervical biopsy.
Materials and methods: The study was conducted among 125 patients who have undergone both Pap smear and colposcopy-guided cervical biopsy using a cross-sectional study with a purposive sampling method. The data obtained were analyzed statistically.
Results: 125 patients participated in this study, giving Pap smear a sensitivity of 38%, specificity of 64%, positive predictive value of 80.85%, negative predictive value of 20.51%, false-positive for intraepithelial lesion or malignancy of 38%, false-negative for intraepithelial lesion or malignancy 62%. Of the total 125 patients studied, 62.4% were indicated to have a cervical biopsy due to clinical suspicion and among them biopsy report was positive for intraepithelial lesion or malignancy in 79.5%.
Conclusion: The sensitivity and specificity of Pap smear as a screening tool for precancerous cervical lesions is low. It is therefore inadequate to be used alone as a screening tool. The study also shows that having a high index of clinical suspicion even when the Pap smear results were normal was important in order not to miss a precancerous cervical lesion as early detection can prevent progression to cervical cancer. Hence, a more experienced doctor with a high index of clinical suspicion is vital.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359–E386. DOI: 10.1002/ijc.29210.
Ministry of Health Malaysia. Clinical Practice Guidelines Malaysia—Management of Cervical Cancer, 2nd ed.; 2015. p. 1.
Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999;318:904. DOI: 10.1136/bmj.318.7188.904.
Beckmann C. Obstetrics and Gynecology, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. p. 601.
Chase DM, Kalouyan M, DiSaia PJ. Colposcopy to Evaluate Abnormal Cervical Cytology in 2008. Am J Obstet Gynecol 2009;200:472–480. DOI: 10.1016/j.ajog.2008.12.025.
Park K. Park's Textbook of Preventive and Social Medicine, 22nd ed.; 2013. pp. 127–129.
Ministry of Health Malaysia. Consensus Guide to Adult Health Screening for General Population Attending Primary Care Clinics. Family Medicine Specialists Association of Malaysia. p. 37.
Sasieni P, Castanon A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 2009;28:339. DOI: 10.1136/bmj.b2968.
Stöppler M. Pap Smear: Facts, Procedure & Guidelines, online 2016; available from: http://www.medicinenet.com/pap_smear/article.htm, [accessed on 2016 Nov 09].
Cancer.org. The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer. Online 2018 Dec 18. Available from: http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervical-cancer-prevention-and-early-detection-cervical-cancer-screening-guidelines, [accessed on 2016 Nov 09].
U.S. Preventive Services Task Force. Final Update Summary: Cervical Cancer: Screening. Online;2018 Aug. Available from: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening2, [accessed on 2018 Aug].
Solomon D. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287:2114–2119. DOI: 10.1001/jama.287.16.2114.
Guidebook for Pap smear screening, Division of Family Health Development, Ministry of Health Malaysia, online; 2003. Available from: http://www.moh.gov.my/medical/HTA/cpg.htm, [accessed on 2019, Mar].
Jeronimo J, Schiffman M. Colposcopy at a crossroads. Am J Obstet Gynecol 2006;195:349–353. DOI: 10.1016/j.ajog.2006. 01.091.
Cantor S, Cárdenas-Turanzas M, Cox D, Atkinson E, Nogueras-Gonzalez G, Beck J, et al. Accuracy of Colposcopy in the Diagnostic Setting Compared With the Screening Setting. Obstet Gynecol 2008;111:7–14. DOI: 10.1097/01.AOG.0000295870.67752.b4.
Massad L, Jeronimo J, Schiffman M. Interobserver Agreement in the Assessment of Components of Colposcopic Grading. Obstet Gynecol 2008;111:1279–1284. DOI: 10.1097/AOG.0b013e31816baed1.
The American College of Obstetricians and Gynecologists, ACOG Practice Bulletin No. 99: Management of Abnormal Cervical Cytology and Histology. Obstet Gynecol 2008;112:1419–1444. DOI: 10.1097/AOG.0b013e318192497c.
Karimi-Zarchi M, Peighmbari F, Karimi N, Rohi M, Chiti Z. A Comparison of 3 Ways of Conventional Pap Smear, Liquid-Based Cytology and Colposcopy Vs Cervical Biopsy for Early Diagnosis of Premalignant Lesions or Cervical Cancer in Women with Abnormal Conventional Pap Test. Int J Biomed Sci 2013;9:205–210.
Jhala D, Eltoum I. Barriers to adoption of recent technology in cervical screening. Cytojournal 2007;4:16. DOI: 10.1186/1742-6413- 4-16.
Syrjänen K, Derchain S, Roteli-Martins C, Longatto-Filho A, Hammes LS, Sarian L. Value of conventional pap smear, liquid-based cytology, visual inspection and human papillomavirus testing as optional screening tools among latin american women <35 and > or =35 years of age: experience from the Latin American Screening Study. Acta Cytol 2008;52:641–653. DOI: 10.1159/000325616.