PAP TEST AND ITS IMPORTANCE IN DETECTION AND PREVENTION OF PREMALIGNANT AND MALIGNANT LESIONS OF THE CERVIX

Abstract

According to global statistics, 80% of all cervical cancer cases are found in developing countries due to a lack of awareness and difficulties in implementing cytology-based screening programs. Due to widespread screening programs, there has been a significant reduction in cervical cancer mortality in developed countries. Early changes in the cervical epithelium can be identified through the Pap test, which is the primary screening test for detecting precancerous cervical intraepithelial neoplasia and early-stage invasive cervical cancer.
Research objectives: The aim of the study was to determine the prevalence of premalignant and malignant cervical lesions using the Pap test, with a focus on their correlation with age and the causative factors of inflammatory changes in the cervix.
Research methods: We conducted a cross-sectional study in the gynecology department of the Health Center Cazin in Bosnia and Herzegovina. The study included patients who were monitored in the department over the course of one year (2024). The target population for cervical cancer screening was women aged 20 years or older. We analyzed 616 patients with documented cytological data from Pap tests. The Pap smears were performed using the conventional method according to standard medical literature. Patients were classified by age into six groups defined by the following intervals: 20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years; 70 years and older. The results of the Pap tests were classified according to the Bethesda system from 2014: Negative for intraepithelial lesion/malignancy (NILM); Atypical squamous cells of undetermined significance (ASCUS); Low-grade squamous intraepithelial lesions (LSIL); High-grade squamous intraepithelial lesions (HSIL); Cervical squamous cell carcinoma (SCC); Atypical glandular cells (AGC). For data analysis, we used the IBM SPSS Statistics program, Version 27. The statistical models used were the Pearson Chi-Square test and Pearson’s moment correlation coefficient.
Results and Discussion: The results indicate that the largest number of participants in our study were in the age group of 40-49 years (187 or 30.4%), followed by the 50-59 years group (168 or 27.3%). A smaller number came from the 30-39 years group (99 or 16.0%) and the 60-69 years group (94 or 15.2%). The smallest numbers were from the 20-29 years group (33 or 5.4%) and the 70 years and older group (35 or 5.7%). In this study, 17 women with ASCUS were from the 40-49 years age group, followed by 10 women from the 50-59 years group and 11 women from the 60-69 years group. LSIL was represented by one case each in the 40-49 years, 50-59 years, 60-69 years, and 70 years and older groups. HSIL was recorded in two patients in the 50-59 years age group. One case of SCC was observed in women from the 30-39 years and 60-69 years groups. One case of AGC was recorded in the 60-69 years age group and two cases in the 70 years and older group. The overall results of the study indicate the frequency of specific cytological findings of the Pap test in our sample of 616 women: NILM-558 (90.6%), ASCUS-47 (7.6%), LSIL-4 (0.6%), HSIL-2 (0.3%), SCC-2 (0.3%), AGC-3 (0.5%).
Conclusions: The one-year cumulative incidence rate in our sample of participants was relatively high (CI 13.58 x 10^5) compared to the targets and strategy of the World Health Organization (CI <4.0 x 10^5). The increased incidence of premalignant and malignant cervical diseases in our population is a result of irregular gynecological check-ups in certain groups of women and insufficient preventive screenings, such as the diagnosis of HPV infections.
Recommendations: Activities regarding the availability, usefulness, and importance of the Pap test should be implemented among all age groups of women, especially in rural areas.