Pap test: significance in early diagnosis of cervical cancer

Sir,

Cervical cancer refers to a malignancy of the lower part of uterus i.e. cervix. It is the fourth most prevalent among women worldwide and tallies for about 30% of cancer cases in the developing world and 5% in the developed world.¹ Pap test, is a diagnostic procedure to assess cervical cancer in women. It involves gathering cells and scrutinising potentially precancerous and cancerous lesions in the cervix.² However, lack of knowledge and untimely screening has made this potentially preventable illness, a hazardous one. In a study conducted amongst women in Iran, only 44.3% were aware of the Pap test.³ Numerous factors account for surging cases of this cancer worldwide. A paucity of information coupled by a lack of recommendation by physicians remains a major impediment in detection of cervical cancer. There is a dearth of provision of these tests in local residential areas and therefore, people have to travel vast distances; something that they tend to avoid. Shyness also remains a key concern since females are not comfortable during examination of their perineum.³ All these elements have summed up to make this one of the top causes of cancer-related mortality globally.

The lack of awareness is not congruent to lack of knowledge. The main facet behind the sheer low level of awareness is the shortfall of medical understanding. Many doctors fail to elucidate the testing procedure to patients and thereby don’t even relay it as a viable option. The lack of fundamental knowledge results in increasing levels of misconceptions. The misapprehensions usually involve shying away from testing due to a widely carried notion: once vaccinated for HPV, the screening is deemed redundant.⁴ A study conducted in the US revealed how participants incorrectly believed that the Pap smear tests for HPV (82%-91%), HIV/AIDS (22%-59%), and pregnancy (17%-38%).⁵

Systematic methods could be instilled to better the current level of understanding. Firstly, awareness campaigns could be organized to encourage knowledge regarding cervical cancer screening. To eliminate the aspect of shyness, self-sampling could be introduced. Moreover, health nurses should be encouraged to amp up their contribution in providing services to vulnerable women. Lastly, cost effective strategies should be utilized and screening reminders should be sent out publicly to expand the ambit of awareness.

This letter aims to highlight the significance of punctual Pap smears in the female population all over the world. It is pertinent that health care professionals play their pivotal role in creating awareness and encouraging females to routinely undergo the test. In spite of all the efforts, further research is imperative to strategize against this problem and control it effectively.

REFERENCES

1. 1. Khazaei Z, Sohrabivafa M, Mansori K, Naemi H, Goodarzi E. Incidence and mortality of cervix cancer and their relationship with the human development index in 185 countries in the world: An ecology study in 2018. Adv Human Biol. 2019;9(3):222-27.
2. 2. Najib FS, Hashemi M, Shiravani Z, Poordast T, Sharifi S, Askary E. Diagnostic Accuracy of Cervical Pap Smear and Colposcopy in Detecting Premalignant and Malignant Lesions of Cervix. Indian J Surg Oncol. 2020;11(3):453-8.
3. 3. Rezaie-Chamani S, Mohammad-Alizadeh S, Kamalfard M. Knowledge, Attitudes and Practice about Pap Smear among Women Reffering to A Public Hospital. J Fam Reprod Health. 2012;6(4):177-82.
4. 4. Comparetto C, Borruto F. Cervical cancer screening: A never-ending developing program. World J Clin Cases. 2015;3(7):614-24.
5. 5. Daley E, Perrin K, Vamos C, Hernandez N, Anstey E, Baker E, et al. Confusion about Pap smears: lack of knowledge among high-risk women. J Womens Health (Larchmt). 2013;22(1):67-74.