الفهرس 
Review of literatureOnly 14 pages are availabe for public view
 |  | from | 141 |  |  |
| | | from | 141 | | |
Abstract
According to the World Health Organization, cervical cancer is the second most common type of cancer among females, and was responsible for over
250,000 deaths in 2005. Approximately 80% of these deaths occurred in developing countries. Without urgent intervention, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. (Edmonds DK, 2008.)
Cancer cervix has been considered preventable because it has a long preinvasive state and availability of screening programs and treatment of preinvasive lesions is effective. It has been well established that well-organized screening by cytology has substantially reduced the incidence of morbidity and mortality from cervical cancer in developed countries.( Anttila A, Ronco G, et al 2004.)
Since 1943, Pap smear cytology has been used for the screening of cervical cancer. However, the best method for cervical cancer screening still remains unclear. Literature recommends different methods ranging from simple cytology, colposcopy, and human papilloma virus (HPV) deoxyribonucleic acid (DNA) testing or even repeat cytology.( Smith RA,et al 2004.)
Colposcopy is a diagnostic procedure to examine an illuminated magnified view of the cervix and tissues of the vagina and vulva. Many premalignant and malignant lesions in these areas have noticeable characteristics which can be detected through colposcopy. Colposcope helps to visualize the cervix and distinguish normal from abnormal areas and to take direct biopsies from abnormal areas for further
pathological evaluation. The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and treat them. (Jordan et al., 2009).
Colposcopy is used currently as a triage test in cervical cancer prevention. It helps to diagnose the patients in pre malignant stage and categories the women in a better way related to the need of treatment. . ( Massad LS et al, 2009.)
Colposcopy and cytology detects preinvasive lesions in 99% of cases. Although systematic cytological screening has decreased the incidence and mortality rates of cervical cancer. Women’s lack of knowledge and misconceptions of cancer screening often cause delays in diagnosis and treatment.
Women experience high levels of anxiety and negative emotional responses at all stages of cervical screening. Fear of discovering cancer, embarrassment, physical discomfort, and lack social support discourage female cancer prevention behavior.
This study was carried out in outpatient clinic in Benha university hospital, early cancer detection unit. The study includes 300 women subjected for Pap smear and for Gynocular colposcopy and CGB. Informed consent was taken from every patient and questionnaire was filled by the candidate.
We considered Pap smear result suggestive for the presence of cervical neoplasia when we found (ASUS, AGUS, LSIL, HSIL).
We considered histopathological examination suggestive for the presence of cervical neoplasia when we found (CINI, CINII, CINIII, and SCC).
The questionnaire was developed to assess knowledge and attitude of patient to Pap smear and colposcopy. The questionnaire consisted of many questions, including questions about age, parity, menstruation, knowledge about Pap smear, colposcopy, cervical cancer, sources of these knowledge, reasons for doing Pap smear or colposcopy, and believes of women about the importance, side effects, and the benefits of the procedure.
The study included 300 patients; conventional Papanicolaou (Pap) smears were applied on all patients and evaluated using the Bethesda system followed by colposcopic guided biopsy (CGB) for all epithelial abnormalities which obtained from Pap smears. As regard Pap smears of 300 cases, 60 (20%) cases showed epithelial abnormalities (EA), however 240 (80%) cases without EA.
The age of studied group ranged from (20-64) years with mean and standard deviation (SD) 35.5±7.9 . Most of cases were multiparous with mean and standard deviation (SD) 2.8±1.0.
In our work cytology matched histopathological result in predicting CIN and by colposcopic examination of abnormal transformation zone suggestive for CIN (acetowhite area with no uptake of iodine).
from our study we can detect the prevalence of CIN in 300 cases attended to outpatient clinic at Benha University Hospital.
We concluded that Pap smear had high specificity& diagnostic accuracy and moderate sensitivity in diagnosis of CIN, while gynocular colposcopy had perfect sensitivity and high specificity& diagnostic accuracy.
Media and education need to provide clear and palatable message to the public by explanation the value of screening. Health insurance services and improving family income has a positive impact in increasing health perception and cancer screening. Policy makers and health care providers should have an important role in increasing the coverage of screening services.