International Journal of Biomedical and Advance Research 205

PROFILE OF CERVICAL SMEAR CYTOLOGY IN WOMEN ATTENDING

HEALTH CENTER IN RURAL AREA OF WESTERN MAHARASHTRA
Jayant D Deshpande*, Deepak B Phalke, Vaishali D Phalke
Rural Medical College. Pravara Institute of Medical Sciences, Loni, India
E-mail of Corresponding Author: drjayant10@gmail.com
*

Abstract
Background: Cervical cancer caused by infection with a sexually transmitted agent human
papillomavirus (HPV), can be readily prevented by identifying and treating women with HPVinduced precancerous lesions of the cervix.
Objective: To study the profile of cervical smear cytology in rural women in western Maharashtra.
Methods: The study was designed to look at the previous reports of the Pap smear present at the
health center Pravaranagar in rural area of Western Maharashtra. The reports of 186 smears were
analyzed.
Results: Maximum numbers of the women (70.43%) were less than 40 years of age. Majority of the
women were from lower socio-economic status. There were 29.03 % Pap smears, negative for
intraepithelial lesion. Intraepithelial neoplasia of various grade and invasive cervical carcinoma were
diagnosed in some cases. Other infections were also detected on Pap smear like bacterial vaginosis,
candidial infection and trichomonas vaginalis infestation.
Conclusion: An Awareness and education program needs to be implemented to target women about
cervical cancer and Pap smear screening. The goal of any screening programme should be to pick up
majority of the precursor lesions and not frank cancers; it is desirable to initiate Pap smear screening
in women from lower socio-economic status before the 40 years of age.
Keywords: Pap smear, Rural women, Neoplasia, Cervical infections, Profile
1. Introduction
Cervical cancer caused by infection with a
sexually
transmitted
agent
human
papillomavirus (HPV), can be readily prevented
by identifying and treating women with HPVinduced precancerous lesions of the cervix.1
Cervical cancer has a long premalignant phase.
If it is detected and treated in this phase,
advanced
disease
can
be
prevented.
Unfortunately, more than 80% of cases are
diagnosed at an advanced clinical stage when
five-year survival is less than 40%.2 In 1941
Papanicolaou described cervical mass screening
for early detection of cancer cervix and early
pre-cancerous lesions. Uterine cervical cancer is
a favorable site for an effective control program.
The long latent period of intraepithelial
neoplasia and availability of easy and sensitive
screening test like the pap smear make the
cervix a useful site to screen for cancer.3
Nationwide, the disease accounts for an
estimated 24 % of Indias cancer cases among
women, compared with 20 percent for breast
cancer. 4 Indias National Cancer Control
Program emphasizes the importance of early
detection and treatment. Poor and rural women
are at heightened risk for cervical cancer.
Routine clinical screening of all women
attending the rural hospitals irrespective of their
complaint could detect cancers in the early

stages. The absence of a preventive attitude

towards one's health was noticeable among these
women. In fact, they believed that in the absence
of symptoms, there is no need for a Pap smear.5
Present study is an attempt to study the profile of
cervical smear cytology in women attending
health center, Pravaranagar.

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2. Material and Method

Routine cytological evaluation of cervical smear
is carried out in women attending Outpatient
Department
(OPD)
at
health
center,
Pravaranagar. Their detailed clinical history
particularly obstetric and menstrual history
along with clinical examination findings and
relevant investigations were recorded. Pap
smears of these women were collected. The
study was designed to look at the previous
reports of the Pap smear. The study group
comprised of 186 cervico-vaginal smears from
women who attended the health center, which
included cervical smear screening. All smears
were taken by trained female health worker.
There were no exclusion criteria in this study, so
all the smears were included in the study. The
samples were collected using Ayer's spatula.
The smears were then fixed in alcohol and
stained using the Papanicolaou's technique. All
the smears were reported by pathologists at
Rural Medical College using the Bethesda

Research ArticleDeshpande et al206

System. Reports of 186 smears were analyzed.

The cervical Pap smears examination of all the
All the known abnormalities were identified and
women with vaginal discharge showed the
stated in this reports. Analysis of data was done
presence of cervical infections (Table 3). The
in the form of age wise distribution of women,
sexually transmitted diseases (STD) namely
chief complaint and percentage distribution of
Trichomonas vaginalis and Candida albicans
each diagnosis. The smears were categorized
were also diagnosed in the cytology smears.
into different groups as prevalence of normal
smears, non specific infections, and specific
Table 3. Pap smear profile
infections, other reactive changes and epithelial
Diagnosis
No
%
abnormalities. Modified Prasads classification
Negative for intraepithelial lesion
54
29.03
adjusted with current price index was used to
Reactive cellular changes with
determine socio-economic status (SES).6
3. Results
Maximum numbers of the women (70.43%)
were less than 40 years of age. They were
ranging in age from 18 to 64 years with a mean
of 35.3 years and standard deviation (S.D.) of
8.6 years. Age wise distribution of these women
is presented in Table 1.
Table 1 Age wise distribution of women
Age interval
No.
%
(Years)
18-29
58
31.18
30-39
73
39.25
40-49
47
25.27
50
8
4.30
Total
186
100
Of the 186 women, the majority were married
before 19 years of age (68.5%) and 67.4%
delivered their first child within 1-2 years.
Pelvic pain (lower backache, pain in abdomen)
was the most common presenting complaint
(72.04%) of the women screened. Abnormal per
vaginal discharge was the second most common
presenting complaint (45.69 %). Urinary
symptoms were present in 9.67% of women.
Inter-menstrual bleeding was present in 4.3 % of
women.
It is evident from Table 2 that, Majority of the
women were from lower (social class IV+V)
socio-economic status (52.16%).
Table 2 Socio-economic status of women
Social Class
Class IUpper Class
Class II
Upper Middle
Class IIILower Middle
Class IV
Upper Lower
Class V-Lower
Total

Per Capita
Income/Month(Rs
.)

No. (%)

>2510

9(4.84)

1255-2509

24(12.90)

753-1254

56(30.10)

376-752

67(36.03)

<375

30(16.13)
186(100)

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inflammation with trichomonas

vaginalis infestation
Reactive cellular changes with
inflammation with candidial
infection
Reactive cellular changes with
inflammation with bacterial
vaginosis
Reactive cellular changes with
non specific inflammation
Acute inflammatory cells with
dysplasia
Low
grade
squamous
intraepithelial lesion (LGSIL)
High
grade
squamous
intraepithelial lesion (HGSIL)
Signs of Invasive squamous cell
carcinoma
Total

21

11.29

13

6.99

37

19.89

51

27.42

02

1.07

05

2.69

02

1.07

01

0.54

186

100

Vaginal discharge may be pathogenic or even

nonpathogenic which needs early detection of
cause and appropriate treatment. Presence of
Leucorrhoea was one of the commonest
gynecological morbidity among these women.
Out of 186 cases there were 21 (11.29%)
trichomonas vaginalis infestation, 13 (6.99%)
fungal organisms morphologically consistent
with Candida species and 37 (19.89%) bacterial
vaginosis. Intraepithelial neoplasia of various
grade and invasive cervical carcinoma were also
diagnosed in some cases. In present study 3
women (age >47, Parity-3 or more) had HGSIL
and invasive cancer. They had pelvic pain,
postmenopausal bleeding, discharge per
vaginum and cervical erosion.
Cervical precancers have been classified in a
variety of ways. The oldest system is the
dysplasia/carcinoma in situ system with mild
dysplasia
on
one
end
and
severe
dysplasia/carcinoma in situ on the other. Richart
introduced the term cervical intraepithelial
neoplasia (CIN). In Richarts system, CIN I
corresponded to mild dysplasia.CIN 2
corresponded to moderate dysplasia, and CIN 3
corresponded to severe dysplasia and to
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Research ArticleDeshpande et al207

Trichomonas vaginalis. 12 Teresita et al (2001)

carcinoma in situ.7 The Bethesda System was
developed to replace the various Papanicolaou
observed that the sensitivity of the Pap smear for
designations and to standardize cytologic
Candida species was 31%, for bacterial
terminology to correlate with the histology
vaginosis 57%, and 51% for trichomonas
reports. The most significant development in
vaginalis. He concluded that the sensitivity of
nomenclature is the creation of broad categories
Pap smears for Candida species bacterial
of atypical squamous and glandular cells of
vaginosis, and Trichomonas vaginalis is
undetermined significance (ASCUS and AGUS)
inadequate for screening. Pap smears that are
and low- grade and high-grade squamous
positive for Trichomonas vaginalis could be
intraepithelial lesions (LGSIL, HGSIL). LGSIL
used to complement the diagnosis.13
encompasses Class III, mild dysplasia, CIN I,
It is fortunate that the uterine cervix is an
and infections with human papillomavirus.
accessible site with early symptomatology. The
HGSIL encompasses Papanicolaou Classes III
negative aspect is the ignorance of the rural
and IV, moderate dysplasia, severe dysplasia,
women, the traditional reluctance of women to
CIS, and CIN 2 and CIN 3.8,9
seek medical aid, especially for gynecologic
complaints, added to the readily available,
indigenous medical quackery. The women in
4. Discussion
rural areas have to work very hard and they live
The cervix is both a sentinel for potentially
in very poor conditions. The health beliefs of
serious upper genital tract infections and a target
individuals are strong determinants in their
for viral and other carcinogens. Infection
choice of action. Women require more
constitutes one of the most common clinical
information about cervical cancer and need of
complaints in gynecologic practice and
Pap smear screening.
frequently vexes both patient and clinician.
Present work has been undertaken mainly to
study profile of precancerous and cancerous
Conclusion
An Awareness and education program needs to
lesions as well as inflammatory lesions in female
be implemented to target rural women about
patients living in rural area. In present study
cervical cancer and Pap smear screening. Since
much credit for early detection of precancerous
the goal of any screening programme should be
lesion belongs to the effectiveness of the
to pick up majority of the precursor lesions and
Papanicolaou cytologic test. In present study
not frank cancers, it is desirable to initiate Pap
low grade squamous intraepithelial lesion was
smear screening in women from lower sociopresent in 2.69% and high grade squamous
economic status before the 40 years of age.
intraepithelial lesion in 1.07% and invasive
squamous cell carcinoma 0.54% of women. In
hospital based study by Misra et al(2009) in
Acknowledgement
We acknowledge help and support from the
North India the frequency was found to be, low
Management of Pravara Medical Trust, The
grade squamous intraepithelial lesion 5.5%,
Principal and Department of Pathology Rural
high grade squamous intraepithelial lesion 1.6%
Medical College, Loni.
and carcinoma 0.6%.10 Altaf Fadwa (2006)
reported 4.7 % of abnormal pap smears. The
significant categories were atypical squamous
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