Insights Of Free Cervical Cancer Screening Camp Held at A Tertiary Care Hospital - A Step Towards the Rise of Preventive Approach in Healthcare.

Globally, there are an estimated 20 million new cases of cancer and 9.7 million deaths attributed to cancer. Among women worldwide, cervical cancer ranks as the fourth most common cancer, following breast, lung, and colorectal cancers. However, in India, cervical cancer is the second most common cancer affecting women, trailing only breast cancer.¹ (Globocon,2022). This significant prevalence underscores the critical public health challenge posed by cervical cancer in the country. Each year, there are about 660,000 new cases of cervical cancer diagnosed and 350,000 deaths, with over 90% of these cases occurring in developing countries. By 2050, it is projected that there will be one million new cases annually, with 90% still concentrated in developing countries.² (WHO fact sheets,2024). This high prevalence underscores the urgent need for effective prevention and control measures.

India accounts for approximately one-sixth of the global burden of cervical cancer and one-fifth of the global deaths from the disease. India reported approximately 123,907 new cases of cervical cancer, with around 77,348 deaths attributed to the disease.³

With a population of 511.4 million women aged 15 years and older who are at risk³, there is a critical need for comprehensive cervical cancer prevention strategies, including improved screening, vaccination programs, and public awareness campaigns to address this significant health challenge.

Cervical cancer is essentially preventable cancer as it has long pre-invasive stage. It has been shown that it is possible to screen and treat cervical cancer in early stages with high success even in rural India⁴

WHO has recommended elimination of cervical cancer by doing 90% coverage of HPV vaccination of girls aged 9 to 14 years. 70% screening with high performance test of women aged between 35 to 45 years.

90% of women identified should receive treatment for precancerous lesion or invasive cancer⁴

This study of Pap Smear Screening Camp held at DVVPF’s Medical College and Hospital, Ahilyanagar is a step to study the importance of the parameters used in early detection of Cervical Cancer. This study is to know the prevalence of pre-invasive lesion of cervical cancer via Pap smear screening.

 

Table 1: Age Distribution

 

Table 2: Spectrum of Pap Smear Abnormalities

 

Table 3: Correlation of Age with Various Lesions

 

Table 4: Distribution of Symptoms

 

Table 5: Distribution of Per Speculum Findings

 

Table 6: Correlation of Symptoms with Various Lesions

 

 

Table 7: Correlation of PV Findings with Various Lesions

Pap Smear Findings	PV Findings
	Healthy Cervix	White PV Discharge	Hypertrophic Cervix	Cervical Erosion/ Ectropion	Cervix bleeds on touch	UV Prolapse	Post Menopausal Bleeding
Unsatisfactory Smears	04	01	00	01	01	00	01
NILM	99	24	06	11	03	00	00
Inflammatory Smears, NILM	27	08	00	04	01	00	00
Inflammatory Smears	01	02	00	00	00	00	00
Atrophic Smears, NILM	03	00	00	00	00	00	01
Atrophic Smears	02	00	00	00	00	00	00
ASCUS	06	00	00	00	00	00	00
ASCH	01	00	00	00	00	00	00
LSIL	01	00	00	01	00	00	00
HSIL	03	00	00	00	00	00	00
SCC	00	00	00	00	00	00	00
AGC	00	00	00	00	00	00	00
Adeno. CA.	00	00	00	00	00	00	00

 

This research discusses the prevalence of cervical cancer at a tertiary care hospital among patients attending free cervical cancer screening camp held at DVVPF’s Medical College and Hospital, Ahilyanagar, Maharashtra, India.

Total of 211 participants were taken into consideration for study out of which 40 participants i.e.18.95% were from age group under 30 years of age, 106 participants i.e. 50.23% were from 31 to 40 years i.e. reproductive age group, 46 participants i.e. 21.80% from 41-50 years of age group i.e. perimenopausal age group, while 19 participants i.e. 9% participants were from age group above 50. A few pap smears of about 9 participants were regarded as unsatisfactory due to various reasons most common being paucicellulararity of smears and others being superficial smear collection and haemorrhagic smears.

The whole spectrum of pap smear abnormalities was studied including NILM, NILM with Inflammation, Inflammatory Smears only, NILM with Atrophic changes on smear, Atrophic Smears only, ASC-US, ASC-H, LSIL, HSIL, Squamous Cell carcinoma, AGC and Adenocarcinoma. The most common finding among these was found to be NILM with 142 participants, another group of 37 women had NILM with Inflammation, few women to be precise 4 had NILM with atrophy while in about 3 participants each only Inflammation and Atrophy was found. 6 women were reported as having ASC-US, only 1 was reported ASC-H, LSIL was reported in 2 participants while HSIL was reported in 4, other abnormalities were not reported in any of the participants taken for study.

A correlation of various lesions as above was done with age group and it was found that in less than 30 years age group with total 40 participants, 27 were reported with NILM, 12 had NILM with Inflammation and 1 participant was reported with HSIL. In the age group of 31-40 which had maximum participants of 106, 76 were reported with NILM, 20 had NILM with Inflammation, 2 were reported as Inflammatory Smears only, 2 were reported as having ASC-US, 1 participant each was reported under category of ASC-H, LSIL and HSIL while the Smears of 3 participants were considered to be unsatisfactory for any opinion due to paucicellulararity of smears. In age group of 41-50 years of age with total of 46 participants 31 were reported as NILM, 5 had NILM with Inflammation, 1 participant was reported as having Inflammatory Smears, 1 participant had NILM with Atrophic changes on smear. 2 women from this age group were reported with

ASC-US and 1 participant each was reported under LSIL and HSIL category in this age group while 4 were considered as having unsatisfactory smears as 2 were paucicellular, 1 participant’s smear showed only endocervical cells denoting superficial smear collection, while 1 participant’s smear was found to be haemorrhagic i.e. blood obscuring the target cells. From the age group of greater than 50 years of age which had total 19 women, 8 were reported with NILM, 3 were reported having NILM with atrophic changes on Smears, while 3 were reported as having Atrophic Smears only. 2 women from this age group were reported with ASC-US and 1 was reported with HSIL while 2 participants from this age group had unsatisfactory smears for reporting due to paucicellularity of smears.

Distribution of symptoms and also PV findings were taken into consideration as provided in the requisition sent by the Obstetrics and Gynaecology Department and a correlation of these was done with the pap smear lesions as discussed in tables above. Out of 211 about 147 participants were asymptomatic and had healthy looking cervix while 35 had white PV discharge, 9 were reported with pain in abdomen, 2 participants had post coital bleeding, 15 had Irregular bleeding and 6 had Frequency of Micturition while no women had complaint of something come out per vaginum. Out of the PV findings excluding 147 participants with healthy looking cervix and 35 with White PV Discharge as symptom and/or PV finding other findings like Hypertrophied Cervix in 6 women, Cervical Erosion in 17, Bleeding Cervix on touch in 5 women and Post Menopausal Bleeding in 2 was found while there was no participant diagnosed having UV Prolapse.

When Symptoms and PV Findings were compared with various pap smear findings it was recorded that 99 participants having NILM were asymptomatic while 24 had White PV Discharge as symptom and/or PV finding, 6 had Pain in Abdomen, 13 had Irregular Bleeding and 5 women had Frequency of Micturition. Also Excluding the 99 asymptomatic women which had healthy looking cervix 6 had Hypertrophied Cervix, 11 had PV finding of Cervical Erosion / Ectropion, and 3 had a finding of Cervical Bleeding on Touch. The women who were reported as having Inflammatory Smears with NILM out of them 27 were asymptomatic while 8 had white PV Discharge and 1 had pain in abdomen, 4 had Cervical Erosion on PV exam while 1 had Cervical bleeding on touch. Out of the 3 women reported as Only Inflammatory Smears 1 was asymptomatic while 2 had White PV discharge. With 4 women reported as Atrophy with NILM, 3 were asymptomatic while 1 had pain in abdomen. Out of 3 women who had Atrophic Smears 2 were asymptomatic while 1 had complaint of Frequency of Micturition. All of the 6 women reported with ASCU-US and 1 women of ASC-H were found to be asymptomatic and had healthy looking cervix, while out of the 2 women having LSIL, 1 was asymptomatic and the other had Cervical Erosion / Ectropion on PV Examination. Out of the 4 women reported as HSIL 3 were asymptomatic while 1 had complaint of Irregular Bleeding.

Alongside the study of routine spectrum of pap smear abnormalities, the pap smear was also simultaneously scanned for various other infections of vagina and cervix and it was found that 1 woman of aged 30 years diagnosed as NILM had Bacterial Vaginosis Infection as the smear showed presence of clue cells while another woman aged 35 years which was reported as ASC-H had Candidiasis infection, which shows that routine pap smear is also useful for opportunistic screening of various other infections of vagina and cervix.

Cervical cancer is a serious health issue in India, with one woman dying from it every 8 minutes.⁷ The cervical cancer screening initiative conducted at DVVPF’s Medical College and Hospital, Ahilyanagar, Maharashtra, India proved to be a valuable public health intervention, offering critical insights into the prevalence and spectrum of cervical cytological abnormalities among women across diverse age groups. With a cohort of 211 participants, the study revealed that the majority of attendees were within the reproductive age group (31-40 years), underscoring the importance of targeting this age group for early detection strategies. The most prevalent cytological diagnosis was Negative for Intraepithelial Lesion or Malignancy (NILM), accounting for over two-thirds of the screened population. However, the detection of premalignant lesions such as

ASC-US, ASC-H, LSIL, and HSIL, though albeit in smaller numbers is significantly important as early detection plays key role for better prognosis in patients with premalignant lesions. Presence of these premalignant lesions in women attending the screening programme highlights the silent progression of cervical pathology and reinforces the necessity of routine screening even among asymptomatic women with clinically normal cervices. A small proportion of smears were deemed unsatisfactory, primarily due to technical limitations such as paucicellularity and haemorrhagic obscuration, indicating a need for enhanced training in sample collection and processing protocols. The study also demonstrated the pap smear’s broader diagnostic utility, with incidental findings of bacterial vaginosis and candidiasis, affirming its role in opportunistic screening for vaginal and cervical infections. Importantly, the correlation between cytological findings and clinical symptoms revealed that a significant number of women with abnormal smears were asymptomatic, emphasizing the inadequacy of symptom-based screening alone. This finding advocates for the integration of routine, population-based cervical cancer screening programs into primary healthcare services, particularly in resource-limited settings. In conclusion, the screening camp not only facilitated early detection of cervical abnormalities but also served as a platform for community awareness and preventive education. Sustained efforts in public health outreach, coupled with improved cytological techniques and follow-up mechanisms, are essential to reduce the burden of cervical cancer and enhance women’s reproductive health outcomes. With 1 in 53 Indian women likely to develop cervical cancer and 8 out of 10 women worldwide getting HPV at some point, regular screening and education are more important than ever.⁸’⁹

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