RETHINKING OPPORTUNISTIC CERVICAL CANCER SCREENING IN RESOURCE-LIMITED SETTINGS: A TEN-YEAR REVIEW OF SCREENING AT BINGHAM UNIVERSITY TEACHING HOSPITAL, JOS, NIGERIA
2 Department of Anatomical Pathology and Forensic Medicine, Faculty of Basic Clinical Sciences, College of Medicine & Allied Health Sciences Bingham University, Jos Campus.
3 Department of Community Medicine & Primary Health Care, Faculty of Clinical Sciences, College of Medicine & Allied Health Sciences Bingham University, Jos Campus.
4 Department of Obstetrics & Gynaecology. Faculty of Clinical Sciences, College of Medicine & Allied Health Sciences Bingham University, Jos Campus.
* Corresponding author: nuhu.tumba@bnghamuni.edu.ng
Abstract
Background: Cervical cancer is the most common gynaecological cancer affecting women in Nigeria. Despite the availability of screening methods for precancerous lesions, screening is largely opportunistic and hospital-based in Nigeria.
Objectives: This study aimed to determine the prevalence and patterns of cervical dysplasia among women in a tertiary health facility in North Central Nigeria.
Methods: A 10-year (2010-2019) review of the results of cervical cytology of 1,124 consecutive women who had cervical smears at Bingham University Teaching Hospital, Jos, Plateau State, Nigeria was done. Classification of cytology results was according to the Bethesda system. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 21. Bivariate analysis was done, and the level of significance was set at P < 0.05.
Results: The mean age was 43.8 ± 10.2 years (range 16 – 85 years). Most women (86.8%) presenting for screening are within the age 30-59 years. 212 (18.9%) of the smear results were abnormal, of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.8% (n = 32), Low Grade Squamous Intraepithelial Lesion (LSIL) was 4.7% (n = 53), Atypical Squamous Cells of Undetermined Significance (ASC-US) was 8.3% (n = 93), Atypical Glandular Cells of Undetermined Significance (AGUS) was 0.4% (n = 4) and Atypical Squamous Cells cannot exclude High-Grade Lesion (ASC-H) was 2.7% (n = 30). 2.3% (n = 26) had inflammatory features. Normal cytological features were present in 78.8% (n = 886). About 84% of HSIL is found within the age group 30-59. There was a significant association between abnormal cervical cytology and increasing age (p < 0.001).
Conclusions: Cervical dysplasia is common accounting for 18.9% of results reviewed. Majority of women screened, and had high-grade lesions are within the age group 30-59 years. While organized routine nationwide screening is yet to be implemented, this study emphasizes the need to maximise opportunistic cervical cancer screening among women in Northern Nigeria.
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