Opportunistic testing of medically underserved women for cervical cancer in south africa

LJ van Bogaert, MD, PhD

Philadelphia Hospital Mpumalanga Department of Hea, Dennilton, Mpumalanga South Africa

Aim: South Africa is in the process of devising a cervical cancer-screening program. Therefore, it is important to establish baseline information in order to devise a program that would meet the goals of an unscreened and underserved population. Methods: Cross-sectional study of 22,160 cervical cytology specimens taken opportunistically in women attending gynaecologic outpatient clinics in the Transkei Region of the Eastern Cape 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 (ISC) was 1.6%. The yield of opportunistic Pap smears was 10.7% including only LSIL and HSIL. Both ASCUS and LSIL peaked between the ages of 21 to 30 years and declined sharply after. The HSIL prevalence peak occurred between the ages of 31 and 40. Of note is the fact that 21.2% of HSIL/ISC were diagnosed at the age of ã 30 years. Our data are in line with other studies from Southern Africa. Conclusion: It appears that the pathologic process of precursor lesions of cervical cancer starts at an early age in Southern African women since more than 20% of cases are diagnosed opportunistically before the age of 30 years.

KEY WORDS: cervical cancer, Pap smear, screening.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Carcinogenesis.