Abnormal Cervical Smear in a Tertiary Hospital in Nigeria

Cervical cancer is one of the most common cancers affecting women worldwide, constituting 6% of all female malignancies. It is the most common female genital tract malignancy in Calabar, Nigeria. Although the incidence and mortality from cervical cancer have decreased substantially in the past several decades among women in the United States, cervical cancer remains the third gynecologic malignancy. When cervical cytology screening programs were introduced into communities, however, marked reductions in the cervical cancer incidence have followed. Carcinoma of the cervix is caused by high risk Human Papilloma Virus (HPV), a sexually transmitted infection. It has a defined premalignant phase of many years, which allows repeated tests to significantly reduce the impact of individual false negative test result and to allow intervention when necessary. There is no organized cervical screening programme in Nigeria, therefore the cervical smear done are basically diagnostic test for symptomatic patients or opportunistic screening for patients who visit the hospital for other conditions. This study is aimed at reviewing the pattern of abnormal cervical smear in Calabar, Nigeria using the Bethesda system of classification and comparing the age distribution of the disease. A cross sectional study of 834 cervical smears seen in Department of Pathology, University of Calabar Teaching Hospital, Calabar within a period of 10 years was analysed. 698 patients had Pap smear that was negative for squamous intraepithelial lesion and 136 had abnormal lesion. Low grade squamous intraepithelial lesion (LGSIL) was seen in 45 cases (43%) while HGSIL were seen in 54 cases (51%). Atypical glandular cells (AGC) was 10 cases (9.5%) while Atypical Squamous cells of Undetermined Significance (ASCUS) was 5 cases (4.8%) and 22 cases (21%) of the abnormal smear were positive for malignancy. There is high incidence of cases positive for malignancy among the abnormal smear with significant number of patients presenting with HGSIL. The results obtained showed that there is an urgent need to sensitize the public about the high prevalence of the disease as well as encourage the Government to embark of population-based screening.