Using the Papanicolaou (Pap) smear for cervical cancer screening in a tertiary care hospital: a prospective study and clinical correlation

Background: Cervical cancer is the most frequent cause of death for women in developing countries.India, the secondmost populous nation in the world, accounts for about 25% of cervical cancer deaths.Even in its premalignant stage, cervical cancer can be detected using a Papanicolaou (Pap) smear test.The goal was to study the role of Pap smear in detecting premalignant, malignant, and non-neoplastic lesions of the cervix and to ascertain the frequency of different lesions.Methods: All women who visited the obstetrics and gynecology outpatient department (OPD) at GMERS Medical College and Hospital, Navsari, India, in 1 year for different clinical problems were recruited.A total of 322 women who were sexually active and over 21 years of age were enrolled in the study.A Pap smear was used for all the women to screen for cervical cancer.The smear was obtained using an Ayre spatula and spread over a marked glass slide, which was placed in 95% ethyl alcohol and sent to the Department of Pathology for cytopathological examination.Women who had visible malignant cervical lesions were excluded.All the data were recorded in a predetermined form.Results: A total of 322 patients were screened.Out of 322, 261 smears were NILM (negative for intraepithelial lesion or malignancy) and 126 (39.1 %) smears had inflammatory changes; 2.2 % and 1.2% smears showed changes as ASCUS (atypical squamous cells of undetermined significance) and ASC-H (atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions), respectively; 4.7 % and 5.3% smears showed LSIL (low-grade squamous intraepithelial lesion) and HSIL (high-grade squamous intraepithelial lesion).Squamous cell carcinoma was observed in only 2 (0.6%) of the smears.A total of 16 (4.9%)smears were unsatisfactory for evaluation because they lacked sufficient squamous components or were obscured by inflammation. Conclusion:The Pap smear test is a very easy, non-invasive, useful, simple, safe, and economical tool to detect preinvasive cervical epithelial lesions.It is evident and proven that every woman above the age of 30-35 years must be subjected to cervical screening, and this must be continued even in the postmenopausal period. HighlightsWhat is current knowledge?The gold standard for cervical screening programs has long been the Pap test, which is straightforward, safe, and affordable.We can identify the precancerous lesions of the cervix by doing routine exams using Pap smear tests. What is new here?Numerous educational initiatives that aid in reducing mortality and morbidity from cervical cancer should inform the population about the test.Every woman over the age of 30 years must get cervical screening in developing nations like India, and this screening must continue even after menopause.The sensitivity of cervical pathology identification can be improved by combining Pap tests with HPV-DNA testing.