Opportunistic Testing of Medically Underserved Women for Cervical Cancer in South Africa

OBJECTIVE To determine the yield of opportunistic Pap smears taken in an unscreened and medically underserved population in the Transkei Region of South Africa. STUDY DESIGN Cross-sectional study of 22,160 cervical cytology specimens from an unscreened population attending gynecologic outpatient clinics between January 1990 and December 1996. RESULTS The overall prevalence of atypical squamous cells of uncertain significance (ASCUS), low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL) was, respectively, 34.7%, 8.3% and 2.4%. The ASCUS: SIL ratio was 3:1. The prevalence of invasive squamous cell carcinoma was 1.6%. The yield of opportunistic Pap smears was 10.7% including only LSIL and HSIL. CONCLUSION The pathologic process of precursor lesions of cervical cancer appears to start at an early age since > 20% of cases are diagnosed before the age of 30 years. In the absence of a national screening program, opportunistic testing of medically underserved women needs to be maintained and encouraged.

[1]  University of ZimbabweJHPIEGO Cervical Cancer Project.  Visual inspection with acetic acid for cervical-cancer screening: test qualities in a primary-care setting , 1999, The Lancet.

[2]  L. Denny,et al.  Cytological screening for cervical cancer--what are its opportunity costs? , 1997, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[3]  S. Fonn.  Cytological screening for cervical cancer--what are its opportunity costs? , 1997, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[4]  K. Khurana.  Comprehensive Cancer Cytopathology of the Cervix Uteri—Correlation with Histopathology. Authors: Y.‐J. Shu and E. Gloor, McGraw Hill, New York, 1995. , 1997 .

[5]  P. Wranz,et al.  Age-specific cervical cytology abnormalities at Tygerberg Hospital , 1997 .

[6]  C. Cralg.  Screening for cervical cancer. , 1996, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[7]  E. de Jonge,et al.  Screening for cervical neoplasia in Mamelodi--lessons from an unscreened population. , 1995, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[8]  E. Gloor,et al.  Comprehensive cancer cytopathology of the cervix uteri : correlation with histopathology , 1995 .

[9]  R. Bailie,et al.  Towards a rational cervical cytology screening strategy. Case study of a peri-urban settlement. , 1995, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[10]  L. Banach,et al.  The most common cancers in Transkeian adults by histological diagnosis. , 1993, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[11]  S. Fonn,et al.  Towards a National Screening Policy for Cancer of the Cervix in South Africa , 1993 .

[12]  C. Lombard,et al.  The natural history of carcinoma of the cervix in young women. , 1992, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[13]  D. Eddy.  Screening for cervical cancer. , 1990, Annals of internal medicine.

[14]  Control of cancer of the cervix uteri. A WHO meeting. , 1986, Bulletin of the World Health Organization.

[15]  C. Vecchia.  The epidemiology of cervical neoplasia. , 1985 .

[16]  C. la Vecchia.  The epidemiology of cervical neoplasia. , 1985, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[17]  C Milligan,et al.  Screening for cervical cancer. , 1975, The American journal of nursing.