Context: Cervical Cancer is the commonest female genital tract  malignancy in the developing world. Though preventable by early detection and treatment of pre-invasive disease, majority of patients in Nigeria still present with advanced disease.Objective: To review the cervical cancer screening exercise of the Medical Women Association of Nigeria and determine the incidence of pre-malignant lesions of the cervix during the study period (1996-2001).Study Design: A descriptive study of women who participated in the exercise and the results of the pap smear.Results: During the exercise 332 women were screened, but only 276 smears (83.1%) were adequately taken and consequently reported. Majority of the smear (75.7%) were normal smears, Cervical Intraepithelial Neoplasia (CIN) was found in 33 smears (12%) and invasive cancer in 1 smear (0.36%). Majority of women with CIN were multiparous and in their 4th and 5th decades of life.Conclusion: The prevalence of CIN is high, thus there is need for routine cervical cancer screening of all sexually active women. Where this is not feasible due to cost and logistics, selective screening of high risk women and use of visual inspection with acetic acid is recommended

Abasiattai, AM

Bassey, EA

Ekanem, MI

Ekpo, MD

English

AJOL - African Journals Online

13Trop J Obstet Gynaecol, 25 (1), April 2008.                                                                                               ISSN 0189 51781,5Introduction disease . To ensure that most women Cervical cancer is the commonest female benefit from cervical screening services, genital tract malignancy in the developing most developed countries have put in place 1-3world  and is responsible for an estimated effective screening programmes. In Nigeria, 231,000 deaths annually, 80%  of which there are few established screening 3,4occur in developing countries . This is programmes and the awareness and unfortunate because cervical cancer is utilization of such facilities is poor, thus the usually preceded by prolonged, pre- majority of patients with cervical cancer malignant phase known as cervical present in advanced stages.intraepithelial neoplasia (CIN) which if detected and treated appropriately will To tackle the problem in this environment, 5prevent invasive disease . Experience from centres with established screening programmes have shown that cervical Cancer screening effectively reduces the incidence and mortality from invasive Cervical Cancer Screening in Uyo, South-South Nigeria 1 2 1 3Emem A. Bassey , Mmefin D. Ekpo , Aniekan M. Abasiattai , Mabel. I. Ekanem  1 2 3Departments of Obstetrics and Gynaecology, Pathology and Haematology, University of Uyo Teaching Hospital, Uyo, P.M.B. 1136, Akwa Ibom State, Nigeria.AbstractContext: Cervical Cancer is the commonest female genital tract malignancy in the developing world. Though preventable by early detection and treatment of pre-invasive disease, majority of patients in Nigeria still present with advanced disease.Objective: To review the cervical cancer screening exercise of the Medical Women Association of Nigeria and determine the incidence of pre-malignant lesions of the cervix during the study period (1996-2001).Study Design: A descriptive study of women who participated in the exercise and the results of the pap smear.Results: During the exercise 332 women were screened, but only 276 smears (83.1%) were adequately taken and consequently reported. Majority of the smear (75.7%) were normal smears, Cervical Intraepithelial Neoplasia (CIN) was found in 33 smears (12%) and invasive cancer in 1 smear (0.36%). Majority of women with CIN were multiparous and in their 4th and 5th decades of life.Conclusion: The prevalence of CIN is high, thus there is need for routine cervical cancer screening of all sexually active women. Where this is not feasible due to cost and logistics, selective screening of high risk women and use of visual inspection with acetic acid is recommended.  Key Words: Cervical, Cancer, Screening, Medical Women Correspondence: Dr. Emem A. Bassey, Department of Obstetrics and Gynaecology,  University of Uyo Teaching Hospital, P.M.B. 1136, Akwa Ibom State Nigeria.  E-mail: basseyemem@yahoo.com1514Trop J Obstet Gynaecol, 25 (1), April 2008.                                                                                               ISSN 0189 5178 Trop J Obstet Gynaecol, 25 (1), April 2008.                                                                                               ISSN 0189 5178the Medical Women Association of Nigeria exercise.(Akwa Ibom State Branch), embarked on a An unlubricated bivalve speculum was used cervical cancer awareness and free to visualize the cervix and the smear was screening exercise in the late 1990s. The obtained with a wooden Ayre's spatula purpose of this paper is to review this placed over the cervical os and rotated cervical cancer screening exercise, through 360 degrees. The collected cervical determine the prevalence of pre-malignant cells were then immediately smeared onto a lesions of the cervix during the study period thin glass slide previously labeled with the and thus join the advocacy for routine patient's name and identity number and cervical cancer screening of all sexually fixed in 95% alcohol. The slides were then active women. transported to the histopathology department of the University of Uyo Materials and Methods: Teaching Hospital where they were stained The monthly cervical cancer screening using the Papanicolaou technique and exercise organized by the Medical Women's reported by a consultant histopathologist.Association of Nigeria, Akwa Ibom State The women were usually given 4-6 weeks Branch between June 1996 to July 2001 was appointment to come back for their results.  reviewed. This exercise was carried out in During this visit, they were counseled and three centres within Uyo the State capital. those with an abnormal smear were referred These centre were:- to a gynaecologist for further assessment.1. St Lukes Hospital, Anua2. University of Uyo Medical Centre Results:3. University of Uyo Teaching Hospital During this period, 332 women were (Formerly Federal Medical Centre) screened , but only 276 smears (83.1%) were reported. Fifty-six smears (16.9%) were These screening exercises were free of inadequate or improperly taken and were charge and open to all sexually active women excluded from further analysis. All the irrespective of age. Baseline information was women screened were or had been sexually obtained from these women on a request active. There was no indication of a previous form and they were counseled on the risk cervical smear by any of them prior to the factors for cervical malignancy and what to exercise.do in the event of an abnormal smear. These The peak of the screening exercise was in the cervical smears were then taken by female year 2000 where 81 smears (29.3%) were medical doctors who had volunteered for the reported (Table 1). The ages of the women Discussionscreened ranged from 17 to 77 (mean 43.5 ± The incidence of CIN in this study was 12% 3.4 years) and the parity from 0-7.6and was similar to 11.8%  reported in Ibadan   7and 12.2% of abnormal smears in Enugu . Of The results of the cervical smears are shown importance however is the fact that these in Table 1. Majority 209 (75.7%) were relatively high incidences in Uyo and Enugu negative smears, followed by inflammatory were obtained in a population of largely changes/chronic cervicitis (10.5%). Cervical asymptomatic women, unlike the study in intraepithelial  neoplasia (CIN) was Ibadan which was hospital based and there diagnosed in 33 smears (12%) and 1 smear were usually indications for the screening. A (0.36%) was suspicious for invasive cancer major draw back however is the small which was confirmed by biopsy.number of women screened in this study when compared with the other two reports.    Table 2  shows the age distribution of women with CIN. CIN was most prevalent in Early detection of cervical cancer is feasible women aged 40-49 years (14.6%). No because the cervix is readily accessible to dysplastic changes were found in women direct visualization and there is exfoliation of less than 20 years of age. The only case of 1,6cervical epithelial cell  .Thus screening invasive cancer diagnosed in this study was procedures such as Pap smears, direct visual in a multiparous (Para 6) 40 years old inspection of the cervix after application of woman.5% acetic acid and more advanced Majority of the women with CIN lesions were procedures like colposcopy and human multiparous, 1 woman (3%) was nulliparous papilloma virus (HPV) DNA testing are and 6 (18.2%) were grand multiparous. The 1,8,9modal parity was Para 3-4. (Table 3). available . The latter are expensive and are not available in low resource settings. In Table 1: Report of the Cervical Cytology    Year 1996 1997 1998 1999 2000 2001 Total (%)Normal Smears 34 11 41 10 65 48 209 (75.7)Inflammatory Smears  6 5 5 - 5 8 29 (10.5)Atrophic Smears - - - 1 2 1 4 (1.4)CIN I 1 4 4 - 3 2 14 (5.1)CIN II 1 1 3 1 5 4 15 (5.4)CIN III 1 2 - - 1 - 4 (1.4)Invasive Cancer  1 - - - - - 1 (0.4)Total 44 23 53 12 81 63 276Table 2: Age distribution of women with CINAge (Years) Number Screened   Number positive (%)   <20        5        -         -   20-29      42           4        (9.5)   30-39     60          8       (13.3)   40-49     82         12       (14.6)   50-59     58         6       (10.3)   60-70     29         3       (10.3)   Total     276        33        (12)TABLE 3: Parity and CINPARITY CIN1  CIN11  CIN111 TOTAL (%)     0 1 - - 1 (3)    1-2 4 5 - 9 (27.3)    3-4 6 9 2 17 (51.5)     5-7 3 2 1 6 (18.2)1716Trop J Obstet Gynaecol, 25 (1), April 2008.                                                                                               ISSN 0189 5178 Trop J Obstet Gynaecol, 25 (1), April 2008.                                                                                               ISSN 0189 5178Nigeria however, there are no public health need to conduct large intervention trails in programmes organized primarily to screen this country to evaluate the effectiveness of 5,6 visual inspection with acetic acid.for pre-malignant lesions of the cervix . Although there are facilities for cytology in There is currently an overwhelming some Nigerian hospitals, these serve only a epidemiological and experimental evidence limited number of women. The only other supporting the aetiological role of certain screening exercises are carried out by non-serotypes of human papilloma virus (HPV) in governmental bodies such as the Medical the development of CIN and cervical Women's Association of Nigeria (MWAN) cancer11. This virus is sexually transmitted and such exercises are usually limited by and it is estimated to take an excess of six poor funding, inadequate logistics and lack 7 years to develop CIN 3 after an initial of public awareness . Even among female infection and an average of 13 years to health professionals, despite being highly develop cervical cancer from normal aware very few of them have ever had a 1210 cytology . Recent evidence also suggests a cervical smear done .                                              strong aetiological role for the Human Immunodeficiency Virus (HIV) as the Cervical cancer screening has reduced the immunodeficiency state imposed by the incidence of invasive cervical cancer and virus is also thought to facilitate the associated mortality when routine screening 131,6,7 development of neoplasia . The prevalence is done especially on nationwide basis . of  both viruses in a population is strongly There are different screening schedules in related to the sexual behavioral pattern, thus different institutions and countries. Yearly in the absence of routine mass screening screening is advocated in some centres and 6 programmes, selective screening of high risk three yearly screening in others . A well-patients including sexual transmitted organized three yearly screening programme 14diseases clinic attendees is recommended .has been shown to decrease the incidence of There is a need for proper training on how to cervical cancer by over 90%1. Mass cervical obtain cervical smears in order to reduce the cancer screening even on a yearly basis in number of inadequate smears, training of this country would constitute a considerable m o r e  c y t o p a t h o l o g i s t s  a n d  t h e  financial and logistic burden. This situation is establishment of more centres with facilities worsened by the paucity of trained for colposcopy and treatment of CIN lesions. cytopathologists in the country. The World Finally, in view of the sexually transmitted Health Organization in recognition of the fact aetiology of CIN and cervical cancer, there is that mass cytology screening programmes a need for more family education life with are simply not feasible in many developing emphasis on pre-marital abstinence and countries is also advocating the use of visual 1,8 mutual fidelity. This will aid in the reduction inspection based screening approaches . of early onset of sexual intercourse, multiple This requires a limited amount of training, sexual partners, multiparty and the but available studies report negative prevalence of HPV and HIV which are known predictive values of over 95%1 and may be risk factors for cervical cancer.suitable for Nigeria. There is however the References1. Teale, GR. The Prevention of Cervical Uterine Cervical Cancer. Bull World Health Intraepitehlial neoplasia. The Obstetrician Organ, 2000; 78:964-967.and Gynaecologist, 2003; 5:21-7 9. Denny L, Kuhn L, Pollack A, Wainwright H, 2. Pindiga HU, EL-Nafaty AU, Ekanem 1A. Wright TC. Evaluation of alterative methods Female Genital Malignancies in Maiduguri, for cervical cancer screening for resource-Nigeria: A Review of 328 Cases. Trop J. poor settings. Cancer, 2000; 89:826-833.Obstet Gynaecol ,1999; 16 (1): 52-56 10. Olaniyan OB, Agboghoroma OC, Ladipo OP. 3. Airede LR, Malami SA. A Five Year Review of Knowledge and Practice of Cervical Female Genital Tract Malignancies in Sokoto, Screening among Female Health Workers in North Western Nigeria. Mary Slessor Journal government hospitals in Abuja metropolis, of Medicine, 2005; 5(1): 51-56. Nigeria. Trop J. Obstet Gynaecol, 2000; 4. Thomas J, Ojemakinde O, Izebvaye I. Current 17:18-20.Concepts in Cervical Carcinogensis and New 11. Walboomers JM, Jacobs MV, Manes MM, Perspectives in Prevention. Arch Ibadan Bosch FX, Kummer A, Shah KV, et al. Human Med, 2002; 3(1): 36-39. Papilloma Virus is a necessary cause of 5. Onah HE, Ezugwu FO, Eze JN. Cervical Cancer invasive Cervical Cancer Worldwide. J. Screening: A Survey of Current Practice Pathol, 1999; 189:12-19.amongst Nigerian Gynaecologists. Trop J. 12. Ostor AG. Natural History of Cervical Obstet Gynaecol, 2001; 18(2): 78-81. Intraepithelial Neoplasia: A Critical Review. 6. Ayinde AE, Adewole, IF, Babarinsa IA. Trends Int. J. Gynaecol Pathol, 1993; 12:186-92.in Cervical Cancer Screening in Ibadan, 13. Olaniyan OB, Denny L. Abnormal Cytology in Nigeria: A four-year review. West Afr. J. Med. H I V- p o s i t i ve  Wo m e n  ref fe red  fo r1998; 17 (1): 25-30. Colposcopy: An Analysis of Cytology-7. Chukwali LI, Onuigbo WIB, Mgbor NC. Colposcope-Histology Correlation. Trop J. Cervical Cancer Screening in Enugu, Nigeria. Obstet Gynaecol, 2005; 22 (2): 129-132.Trop J. Obstet Gynaecol. 2003; 20(2): 109- 14. Omigbodun, AO. Ogunniyi, JO, Adelusi B. 112. Cervical Intraepithelial Neoplasia in a 8. Pa ra s h a r i  A ,  S i n g h  V.  S e h g a l  A ,  sexually transmitted diseases clinic Satyanarayana L, Sodhani P. Gupta MM. population in Nigeria. J. Obstet and Low-Cost Technology for Screening for Gynaecol East Centr Afr, 1988; 74-76.

Cervical Cancer Screening in Uyo, South-South Nigeria

https://www.ajol.info/index.php/tjog/article/download/84990/74962

Cervical Cancer Screening in Uyo, South-South Nigeria

Abstract

Similar works

Full text

Available Versions

AJOL - African Journals Online