RESUMO
OBJECTIVE: To review cervical cancer screening since its introduction to a rural district hospital in Zimbabwe. DESIGN: Retrospective, descriptive. SETTING: Rural district hospital. SUBJECTS: Data from 419 cervical smears performed on women who had cervical cancer screening as part of a routine post partum visit from 1994 to 1996 was available for analysis. MAIN OUTCOME MEASURE: Rates of abnormal cervical smears. RESULTS: The majority of the patients were of age 20 to 29 years (47.2%) and of low gravidity (Zero to three children) 62.6%). A total of 173 slides (41.3%) were normal. Of the abnormal smears, 158 (37%) had inflammation, and 65 cases (15.5%) demonstrated abnormal cytology of which 50 (12%) were low grade squamous epithelial lesions (atypia/CINI), and the remaining 15 (3.6%) high grade squamous intra-epithelial lesions (CIN II/III and carcinoma in situ). CONCLUSION: There was a high frequency of abnormal smears at this rural district hospital. Furthermore, there were problems in sampling the population at highest risk, shortages of supplies, technical problems in sampling and interpretation, and difficulties in follow up of patients. These problems are discussed including the confounding effect of the Human Immunodeficiency Virus.
PIP: In Zimbabwe, where cervical cancer is the leading female malignancy, no systematic cervical screening program has been introduced. However, selective or opportunistic screening has been performed since the late 1980s at family planning clinics, various central and district government hospitals, and in private practice. The initial results of a cervical cancer screening program introduced in a district hospital (Salvation Army Howard Hospital) in the Chiweshe rural community in 1994 were investigated. The aim is for every mother to receive a Pap smear at her 6-week postpartum visit. By May 1996, a total of 419 Pap smears--representing less than 20% of the hospital's postnatal population--had been performed at this facility. If all postnatal visits included a Pap smear, there would have been 2500 screenings. 58.7% of smears were classified as inadequate, primarily because of the coexistence of sexually transmitted infections. A total of 173 slides (41.3%) were normal. Of the abnormal smears, 158 (37.7%) had inflammation. Abnormal cytology was reported in 65 cases (15.5%); 15 of these cases (3.6%) were high-grade squamous intraepithelial lesions. Factors contributing to the low number of Pap smears actually performed included a high default rate for the postpartum visit, shortages of test-related supplies, and the rapid turnover of trained staff. Cervical cancer screening efforts in Zimbabwe require physical resources to perform smears, well-trained personnel, transport and laboratory services, and adequate patient follow up and treatment. Finally, since cervical cancer primarily affects older women, young women of reproductive age may not be the most appropriate target population for screening efforts.