Generic placeholder image

Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Research Article

Risk Factors for the Pap Test Cytological Changes in Iran: A Multicenter Case-Control Study

Author(s): Gita Sangestani, Pantaleo Greco, Ali Reza Soltanian and Mahnaz Khatiban*

Volume 18, Issue 3, 2022

Published on: 05 January, 2021

Article ID: e201021189943 Pages: 9

DOI: 10.2174/1573404817666210105143335

Price: $65

Abstract

Background: Pap tests can detect changes inside the cells of the cervix before cancer develops.

Objective: To compare the risk factors and determinants for abnormal cytological changes in Pap test results among women with and without atypical cytological findings in their Pap test, and to determine the clinical manifestations associated with those changes.

Methods: A multicenter case-control study was conducted in four clinics of gynecology and oncology in Iran. Of a total of 201 women with a result of Pap smear, 51 were cases (atypical cytological findings) and 150 women were control (benign/reactive changes). The data was collected by a researcher-designed tool through the interview, observing medical records and clinical examinations.

Results: According to the logistic regression, the women’s age (OR= 1.08), age at the menarche (OR= 0.75), number of deliveries (OR= 1.44), and BMI (OR= 2.60) are the determinants of the Pap test cytological changes in Iran. Taking hormonal contraceptives, using IUD, sexual activity, and having a family history of cancer are not determinants (p>0.05). The clinical manifestations as having an unhealthy cervix, painful sex, low abdominal pain, pelvic pain, and low back pain were significantly higher (P< .001) in the case group than those of the control group.

Conclusion: The Pap test cytological changes in Iranian women are associated with age, age at the menarche, number of deliveries, and BMI. This information can help healthcare providers to predict their patients' health situation for taking a suitable and quick action.

Keywords: Epithelial cell abnormalities, Iran, papanicolaou smear, prevention, probability uterine cervicitis, women's health.

Graphical Abstract
[1]
Dijkstra MG, Snijders PJ, Arbyn M, Rijkaart DC, Berkhof J, Meijer CJ. Cervical cancer screening: on the way to a shift from cytology to full molecular screening. Ann Oncol 2014; 25(5): 927-35.
[http://dx.doi.org/10.1093/annonc/mdt538] [PMID: 24445150]
[2]
Gedefaw A, Astatkie A, Tessema GA. The prevalence of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia: a cross-sectional study. PLoS One 2013; 8(12): e84519.
[http://dx.doi.org/10.1371/journal.pone.0084519] [PMID: 24376818]
[3]
Levinson KL, Abuelo C, Salmeron J, et al. The Peru Cervical Cancer Prevention Study (PERCAPS): the technology to make screening accessible. Gynecol Oncol 2013; 129(2): 318-23.
[http://dx.doi.org/10.1016/j.ygyno.2013.01.026] [PMID: 23385153]
[4]
Spence AR, Alobaid A, Drouin P, et al. Screening histories and contact with physicians as determinants of cervical cancer risk in Montreal, Quebec. Curr Oncol 2014; 21(6): 294-304.
[http://dx.doi.org/10.3747/co.21.2056] [PMID: 25489256]
[5]
Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. Eur J Cancer 2013; 49(15): 3262-73.
[http://dx.doi.org/10.1016/j.ejca.2013.04.024] [PMID: 23751569]
[6]
Vermandere H, Naanyu V, Mabeya H, Vanden Broeck D, Michielsen K, Degomme O. Determinants of acceptance and subsequent uptake of the HPV vaccine in a cohort in Eldoret, Kenya. PLoS One 2014; 9(10): e109353.
[http://dx.doi.org/10.1371/journal.pone.0109353] [PMID: 25299646]
[7]
Bayrami R, Taghipour A, Ebrahimipour H. Challenges of providing cervical cancer prevention programs in Iran: a qualitative study. Asian Pac J Cancer Prev 2014; 15(23): 10071-7.
[http://dx.doi.org/10.7314/APJCP.2014.15.23.10071] [PMID: 25556428]
[8]
Khodakarami N, Hosseini S, Yavari P, et al. Human papillomavirus infection prevalence in women referred to health clinic of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Majallah-i Ipidimiyuluzhi-i Iran 2012; 7(4): 35-42.
[9]
Farshbaf-Khalili A, Salehi-Pourmehr H, Shahnazi M, Yaghoubi S, Gahremani-Nasab P. Cervical cancer screening in women referred to healthcare centres in Tabriz, Iran. Niger Med J 2015; 56(1): 28-34.
[http://dx.doi.org/10.4103/0300-1652.149167] [PMID: 25657490]
[10]
Sohrabi A, Mirab-Samiee S, Rahnamaye-Farzami M, et al. C13orf18 and C1orf166 (MULAN) DNA genes methylation are not associated with cervical cancer and precancerous lesions of human papillomavirus genotypes in Iranian women. Asian Pac J Cancer Prev 2014; 15(16): 6745-8.
[http://dx.doi.org/10.7314/APJCP.2014.15.16.6745] [PMID: 25169519]
[11]
Damiani G, Federico B, Basso D, et al. Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health 2012; 12: 99.
[http://dx.doi.org/10.1186/1471-2458-12-99] [PMID: 22305108]
[12]
Khorasanizadeh F, Hassanloo J, Khaksar N, et al. Epidemiology of cervical cancer and human papilloma virus infection among Iranian women - analyses of national data and systematic review of the literature. Gynecol Oncol 2013; 128(2): 277-81.
[http://dx.doi.org/10.1016/j.ygyno.2012.11.032] [PMID: 23200918]
[13]
Joy T, Sathian B, Bhattarai C, Chacko J. Awareness of cervix cancer risk factors in educated youth: a cross-sectional, questionnaire based survey in India, Nepal, and Sri Lanka. Asian Pac J Cancer Prev 2011; 12(7): 1707-12.
[PMID: 22126549]
[14]
Anttila A, Lönnberg S, Ponti A, et al. Towards better implementation of cancer screening in Europe through improved monitoring and evaluation and greater engagement of cancer registries. Eur J Cancer 2015; 51(2): 241-51.
[http://dx.doi.org/10.1016/j.ejca.2014.10.022] [PMID: 25483785]
[15]
Ronco G, Dillner J, Elfström KM, et al. International HPV screening working group. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2014; 383(9916): 524-32.
[http://dx.doi.org/10.1016/S0140-6736(13)62218-7] [PMID: 24192252]
[16]
Crum CP, Huh WK. Cervical and vaginal cytology: Interpretation of results (Pap test report). Goff B, Chakrabarti A, editors UpToDate https://www.uptodate.com/contents
[17]
Isidean SD, Franco EL. Embracing a new era in cervical cancer screening. Lancet 2014; 383(9916): 493-4.
[http://dx.doi.org/10.1016/S0140-6736(13)62028-0] [PMID: 24192251]
[18]
Shojaeizadeh D, Hashemi SZ, Moeini B, Poorolajal J. The Effect of Educational Program on Increasing Cervical Cancer Screening Behavior among Women in Hamadan, Iran: Applying Health Belief Model. J Res Health Sci 2011; 11(1): 20-5.
[PMID: 22911943]
[19]
Agénor M, Krieger N, Austin SB, Haneuse S, Gottlieb BR. At the intersection of sexual orientation, race/ethnicity, and cervical cancer screening: assessing Pap test use disparities by sex of sexual partners among black, Latina, and white U.S. women. Soc Sci Med 2014; 116: 110-8.
[http://dx.doi.org/10.1016/j.socscimed.2014.06.039] [PMID: 24996219]
[20]
Kahesa C, Kjaer S, Mwaiselage J, et al. Determinants of acceptance of cervical cancer screening in Dar es Salaam, Tanzania. BMC Public Health 2012; 12: 1093.
[http://dx.doi.org/10.1186/1471-2458-12-1093] [PMID: 23253445]
[21]
Soneji S, Fukui N. Socioeconomic determinants of cervical cancer screening in Latin America. Rev Panam Salud Publica 2013; 33(3): 174-82.
[http://dx.doi.org/10.1590/S1020-49892013000300003] [PMID: 23698136]
[22]
Khodakarami N, Clifford GM, Yavari P, et al. Human papillomavirus infection in women with and without cervical cancer in Tehran, Iran. Int J Cancer 2012; 131(2): 156-61.
[http://dx.doi.org/10.1002/ijc.26488]
[23]
Sangestani G, Greco P, Soltanian AR, Khatiban M. Developing and validating a risk factors assessment tool for the Pap test cytological changes in Iran: A methodological study. Indo American Journal of Pharmaceutical Sciences 2017; 4(11): 3974-81.
[24]
Akinfolarin AC, Olusegun AK, Omoladun O, Omoniyi-Esan GO, Onwundiegu U. Age and pattern of pap smear sbnormalities: Implications for cervical cancer control in a developing country. J Cytol 2017; 34(4): 208-11.
[http://dx.doi.org/10.4103/JOC.JOC_199_15] [PMID: 29118476]
[25]
Balaha MH, Al Moghannum MS, Al Ghowinem N, Al Omran S. Cytological pattern of cervical Papanicolaou smear in eastern region of Saudi Arabia. J Cytol 2011; 28(4): 173-7.
[http://dx.doi.org/10.4103/0970-9371.86343] [PMID: 22090690]
[26]
Yousif HM, Albasri AM, Alshanqite MM, Missawi HM. Histopathological patterns and characteristics of abnormal cervical smear in madinah region of Saudi Arabia. Asian Pac J Cancer Prev 2019; 20(5): 1303-7.
[http://dx.doi.org/10.31557/APJCP.2019.20.5.1303] [PMID: 31127881]
[27]
Kapila K, Sharma PN, George SS, Al-Shaheen A, Al-Juwaiser A, Al-Awadhi R. Trends in epithelial cell abnormalities observed on cervical smears over a 21-Year period in a tertiary care hospital in Kuwait. Sultan Qaboos Univ Med J 2015; 15(1): e112-5.
[PMID: 25685369]
[28]
Shalabi MM, Ismael RI. ur Rahman S, Al Shatry H. Prevalence and risk factors of cervical neoplastic lesions in patients attending a healthcare specialty clinic, King Abdulaziz Medical City, Saudi Arabia. J Cancer Ther 2018; 9(03): 307.
[http://dx.doi.org/10.4236/jct.2018.93028]
[29]
Rositch AF, Nowak RG, Gravitt PE. Increased age and race-specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009. Cancer 2014; 120(13): 2032-8.
[http://dx.doi.org/10.1002/cncr.28548] [PMID: 24821088]
[30]
Fonn S, Bloch B, Mabina M, et al. Prevalence of pre-cancerous lesions and cervical cancer in South Africa-a multicentre study. S Afr Med J 2002; 92(2): 148-56.
[PMID: 11894653]
[31]
Plummer M, Peto J, Franceschi S. International Collaboration of Epidemiological Studies of Cervical Cancer. Time since first sexual intercourse and the risk of cervical cancer. Int J Cancer 2012; 130(11): 2638-44.
[http://dx.doi.org/10.1002/ijc.26250] [PMID: 21702036]
[32]
Natphopsuk S, Settheetham-Ishida W, Sinawat S, Pientong C, Yuenyao P, Ishida T. Risk factors for cervical cancer in northeastern Thailand: detailed analyses of sexual and smoking behavior. Asian Pac J Cancer Prev 2012; 13(11): 5489-95.
[http://dx.doi.org/10.7314/APJCP.2012.13.11.5489] [PMID: 23317205]
[33]
Jensen KE, Schmiedel S, Norrild B, Frederiksen K, Iftner T, Kjaer SK. Parity as a cofactor for high-grade cervical disease among women with persistent human papillomavirus infection: a 13-year follow-up. Br J Cancer 2013; 108(1): 234-9.
[http://dx.doi.org/10.1038/bjc.2012.513] [PMID: 23169283]
[34]
Högnäs E, Kauppila A, Pukkala E, Tapanainen JS. Cancer risk in women with 10 or more deliveries. Obstet Gynecol 2014; 123(4): 811-6.
[http://dx.doi.org/10.1097/AOG.0000000000000182] [PMID: 24785609]
[35]
Sogukpinar N, Saydam BK, Can HO, et al. Assessment of cervical cancer risk in women between 15 and 49 years of age: case of Izmir. Asian Pac J Cancer Prev 2013; 14(3): 2119-25.
[http://dx.doi.org/10.7314/APJCP.2013.14.3.2119] [PMID: 23679329]
[36]
Frumovitz M, Jhingran A, Soliman PT, Klopp AH, Schmeler KM, Eifel PJ. Morbid obesity as an independent risk factor for disease-specific mortality in women with cervical cancer. Obstet Gynecol 2014; 124(6): 1098-104.
[http://dx.doi.org/10.1097/AOG.0000000000000558] [PMID: 25415160]
[37]
Meyer J, Rohrmann S, Bopp M, Faeh D. Swiss national cohort study group. Impact of smoking and excess body weight on overall and site-specific cancer mortality risk. Cancer Epidemiol Biomarkers Prev 2015; 24(10): 1516-22.
[http://dx.doi.org/10.1158/1055-9965.EPI-15-0415] [PMID: 26215293]
[38]
Chelimo C, Wouldes TA, Cameron LD, Elwood JM. Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect 2013; 66(3): 207-17.
[http://dx.doi.org/10.1016/j.jinf.2012.10.024] [PMID: 23103285]
[39]
Lam JU, Rebolj M, Dugué PA, Bonde J, von Euler-Chelpin M, Lynge E. Condom use in prevention of Human Papillomavirus infections and cervical neoplasia: systematic review of longitudinal studies. J Med Screen 2014; 21(1): 38-50.
[http://dx.doi.org/10.1177/0969141314522454] [PMID: 24488594]
[40]
Frazier EL, Sutton MY, Tie Y, McNaghten AD, Blair JM, Skarbinski J. Screening for cervical cancer and sexually transmitted diseases among HIV-infected women. J Womens Health (Larchmt) 2016; 25(2): 124-32.
[http://dx.doi.org/10.1089/jwh.2015.5368] [PMID: 26447835]
[41]
Bal MS, Goyal R, Suri AK, Mohi MK. Detection of abnormal cervical cytology in Papanicolaou smears. J Cytol 2012; 29(1): 45-7.
[http://dx.doi.org/10.4103/0970-9371.93222] [PMID: 22438616]
[42]
Kulkarni PR, Rani H, Vimalambike MG, Ravishankar S. Opportunistic screening for cervical cancer in a tertiary hospital in Karnataka, India. Asian Pac J Cancer Prev 2013; 14(9): 5101-5.
[http://dx.doi.org/10.7314/APJCP.2013.14.9.5101] [PMID: 24175783]
[43]
Gyenwali D, Khanal G, Paudel R, Amatya A, Pariyar J, Onta SR. Estimates of delays in diagnosis of cervical cancer in Nepal. BMC Womens Health 2014; 14(1): 29.
[http://dx.doi.org/10.1186/1472-6874-14-29]
[44]
Vahabi M, Lofters A. Muslim immigrant women’s views on cervical cancer screening and HPV self-sampling in Ontario, Canada. BMC Public Health 2016; 16(1): 868.
[http://dx.doi.org/10.1186/s12889-016-3564-1] [PMID: 27557928]
[45]
Khodakarami N, Farzaneh F, Yavari P, Akbari ME. Cervical cancer screening: Recommendations for muslim societies. Asian Pac J Cancer Prev 2016; 17(1): 239-47.
[http://dx.doi.org/10.7314/APJCP.2016.17.1.239] [PMID: 26838217]
[46]
Siddiq H, Alemi Q, Mentes J, Pavlish C, Lee E. Preventive cancer screening among resettled refugee women from muslim-majority countries: A systematic review. J Immigr Minor Health 2020; 22(5): 1067-93.
[http://dx.doi.org/10.1007/s10903-019-00967-6] [PMID: 31900753]
[47]
Banik U, Bhattacharjee P, Ahamad SU, Rahman Z. Pattern of epithelial cell abnormality in Pap smear: A clinicopathological and demographic correlation. Cytojournal 2011; 8: 8.
[http://dx.doi.org/10.4103/1742-6413.80527] [PMID: 21713015]
[48]
Low EL, Whitaker KL, Simon AE, Sekhon M, Waller J. Women’s interpretation of and responses to potential gynaecological cancer symptoms: a qualitative interview study. BMJ Open 2015; 5(7): e008082.
[http://dx.doi.org/10.1136/bmjopen-2015-008082] [PMID: 26150145]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy