Effectiveness of cervical cancer screening before simple Hysterectomy at Nazareth Mission Hospital

Abstract

Screening for cancer of the cervix is important in any woman after eighteen years or after onset of sexual activity but more so before hysterectomy for benign disease to avoid inappropriate simple hysterectomy in presence advanced cancer of the cervix. This retrospective case series study was done to determine the effectiveness of cervical cancer screening at Nazareth Hospital. The prevalence of various cervical dysplasia found during histology of hysterectomy specimen were determined and compared with preoperative papsmear where one had been done. The 90 files for the study were retrieved in series according to operation dates, for operations done from 31112/2004 backward up to 24/712002. The study found that symptomatic uterine fibroid was the commonest indication for hysterectomy contributing to 72.2%. The mean age at surgery was 44.2years. 32 (35.6%) patients had a preoperative papsmear. Among these, 2 (6.3%) had dysplasia. Histology revealed that out of the 90 patients, I (1.1 %) had CIN I, I (I.I %) CIN2, I(1.1 %) CIN3/CIS and I (1.1 %) had invasive carcinoma. Papsmear screening needs to be improved in the hospital and an urgent audit is needed in our peripheral hospitals to determine their effectiveness in cervical cancer screening. Study of radiotherapy records will also help determine the sources of patients who come- for radiotherapy. Acetic acid aided visual inspection may go a long way in improving screening for the cancer in the country.