Cervical cancer screening by cytology and the burden of epithelial abnormalities in low resource settings: a tertiary-center 42-year study

• Published in: BMC women's health Vol. 24; no. 1; pp. 405 - 10
• Main Authors: Ezzelarab, Sahar, El-Husseiny, Amro, Nasreldin, Magda, Ali, Radwa, Nabhan, Ashraf
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.07.2024; BioMed Central; BMC
• Subjects: Adult; Analysis; Atypical Squamous Cells of the Cervix - pathology; Cancer; Cancer screening; Care and treatment; Cellular biology; Cervical cancer; Complications and side effects; Correlation coefficient; Cytology; Datasets; Demographics; Diagnosis; Early detection of cancer; Early Detection of Cancer - methods; Early Detection of Cancer - statistics & numerical data; Egypt - epidemiology; Female; Gynecology; Health aspects; Health facilities; Human papillomavirus; Humans; Lesions; Longitudinal Studies; Mass Screening - methods; Mass Screening - statistics & numerical data; Medical advice systems; Medical screening; Middle Aged; Obstetrics; Pap smear; Papillomavirus infections; Population; Prevalence; Prevention; Resource-Limited Settings; Risk factors; Squamous cell carcinoma; Squamous intraepithelial lesions of the cervix; Tertiary Care Centers - statistics & numerical data; Trends; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Dysplasia - epidemiology; Uterine Cervical Dysplasia - pathology; Uterine cervical neoplasms; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - pathology; Vaginal Smears - statistics & numerical data; Women; Womens health; Egypt; Cairo Egypt; Uterine cervical neoplasms; Early detection of cancer; Pap smear; Squamous intraepithelial lesions of the cervix; Cervical cancer; Cancer screening
• ISSN: 1472-6874; 1472-6874
• DOI: 10.1186/s12905-024-03254-1

Cytological screening remains a high-impact practice, particularly in low-resource settings, for preventing cervical cancer. The examination of screening practices over time and the prevalence of epithelial abnormalities have not been investigated in longitudinal studies in one of the largest countries in the Middle East and Africa. Routine healthcare data, between March 1981 and December 2022, were extracted from the database of the Early Cancer Detection Unit in a tertiary referral university hospital in the Greater Cairo Region, Egypt. Cervical smears were obtained using a standardized technique and sent to the cytopathology laboratory for conventional cytology examination by expert pathologists. The anonymous data were analyzed to determine the temporal trend of the number of women screened each year and the prevalence of epithelial abnormalities. Data included the results of satisfactory smears from 95120 women. The mean age (SD) of the women at the time of screening was 38.5 (10.5). None of the included women received an HPV vaccine. Abnormal epithelial cells were reported in 5174 women (5.44%). Of these epithelial abnormalities, the majority were low-grade squamous intraepithelial lesions in 4144 women (4.36%). Other abnormalities included atypical squamous cells in 378 women (0.40%), high-grade squamous intraepithelial lesions in 226 women (0.24%), atypical glandular cells not otherwise specified in 184 women (0.19%), adenocarcinoma in 165 women (0.17%), squamous cell carcinoma in 70 women (0.07%), and atypical glandular cells favoring neoplasms in 7 women (0.01%). Women who were at an early age at first intercourse, those who opted for routine cervical cytology screening, and those who were older at screening were more likely to have epithelial abnormalities. The yearly number of screened women was positively associated with the detection of low-grade squamous intraepithelial lesions (correlation coefficient [95% CI] = 0.84 [0.72, 0.91]) and negatively associated with the detection of squamous cell carcinoma (correlation coefficient [95% CI] = -0.55 [-0.73, -0.29]). The small number of annually screened Egyptian women and the temporal trend in epithelial abnormalities critically demonstrate the need for establishing and scaling up a structured population-based program to achieve the goal of eliminating cervical cancer.