Pap smear exam for early detection of carcinoma of cervix uteri-10years prospective study

In recent years Pap. Smears have been proved efficient in reducing mortality from cervical cancer. .However, changes in sexual behavior have posed a threat to this achievement. In Jordan where the population is conservative relative to other societies I have undertaken a prospective study of cervical smears using a non-Arab group of women as control. I reviewed 10659 women during the 10- year period 1982-1991, inclusive .Pap smears were sent either for routine check-up or for cytological diagnosis of cervical disorders. 404 women attended for routine check-up (38%), 3519 women sought medical advice for specific gynecological complaint(s) (33%); the remaining 3092 (29%) came for unspecified reason. Of the total number, 7743 were Arab and 2961 were non-Arab women. One hundred –twenty one cases of Cervical Intra-epithelial Neoplasia (C.I.N) were diagnosed , 88 were nationals and 33 non Arab with frequency rates of 0.9% and 1.1%, respectively .Mean age at the time of diagnosing CIN was 42 years for Jordanian and 34 years for non Arab women , the latter being appreciably younger. Among Jordanian, mean age for the 3 grades of cervical intraepithelial neoplasia went upward from 40 to 41 to 46 in contrast with non Arab women who were on the average 31,35,and 37 years, respectively. Follow-up was adopted in 27 of the 121 women with CIN. Of these 27 women, 14 attended twice, 5 attended 3 times and 8 appeared 4 times for follow-up after diagnosis. Conization and cautery were the principal treatment methods used. All the 27women are now doing well and show no evidence of neoplasia after treatment. Three women turned from negative to positive during the period of this study; their Mean age was 36 years while the mean duration of their follow-up from negative to positive smear was 25 months. In the remaining 29 women, the mean duration of Follow-up was 31 months. Uncircumcised male partners of women without CIN numbered 1163(11% of the total) in contrast with 26 of the 121 of spouses of women with CIN (21%), suggesting a protective role for circumcision. Viral studies were not routinely done while there is evidence that sexually transmitted disease is an infrequent disorder in sexually active Jordanian women.