Role of Colposcopy in Detection of Dysplastic Cervical Lesion as a Screening Tool

Background: Age standardized cervical cancer incidence rate in Nepal is 19.2/100,000 woman, compared with 14.0 worldwide. Similarly, mortality rate is 12.0 women which is significant in comparison with 6.8 worldwide. Cervical intraepithelial neoplasm is a precursor lesion, having high transformation rate into the cervical carcinoma. Data clearly indicates that CIN 2 and 3 has more progression into cervical carcinoma. Despite the fact that Papanicolaou test has remained an important tool in the screening for cervical cancer and has contributed in significant decrease in cervical cancer, sensitivity and specificity of conventional Papanicolaou test is quite low. Colposcopy is visual inspection of cervix under magnification. Study revealed that the positive predictive rate of the colposcopic impression is better as the cervical lesion is more severe. Aim: To find out the significance of colposcopy in the detection of dysplastic cervical lesions and possible use of this method as a screening tool. Methods: This is an observational study done at Cancer Care Foundation, Nepal done from a period of January 2015 to February 2018. Permission was obtained from ethical committee and written consent was obtained from the patients. All the patients suspected having dysplastic or invasive lesions or in whom colposcopy-guided biopsy was performed; were included in the study. Relevant data were collected which included age, colposcopic diagnosis, histopathological diagnosis. Data were entered into Microsoft Excel and statistical analysis was done from statistical package SPSS 21. Results: 6109 females were screened through colposcopy. Out of these 900 patients underwent colposcopy-guided biopsy for being suspected of dysplastic lesions or inflammatory lesions. Mean age of females was 40.65 years. With colposcopy, 407 (45.2%) were suspected to have low grade lesion, followed by 401 (44.6%) high grade lesion and 15 (1.7%) carcinoma. Nonneoplastic lesions were suspected in 77 (8.6%) females. In the histopathological examination low grade dysplasia was observed in 403 (44.8%) followed by 250 (27.8%) high grade dysplasia and 8 (0.9%) carcinoma in-situ or invasive carcinoma. Similarly, 239 (26.6%) patients had nonneoplastic lesions. In colposcopy, high grade lesions were suspected more frequently in females of 41-50 years age group than in 31-40 years age group ( P < 0.01). Correlation between increasing age and dysplastic lesions were also observed ( P < 0.05). There was significant correlation between colposcopic diagnosis and histopathological diagnosis with a P value < 0.01. The sensitivity of colposcopy to diagnose dysplastic lesions were high 96.44% with positive predictive value of 62.65%. The specificity of colposcopy to diagnose various grades of dysplastic lesions is 34.98%. Conclusion: Colposcopy is highly sensitive method of screening dysplastic cervical lesions and should be used more frequently as a screening purpose.

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Comparative Study of Cytology and Histopathology of Cervical Lesion in VIA Positive Patients in Mymensingh

Community Based Medical Journal ◽

10.3329/cbmj.v4i2.53821 ◽

2015 ◽

Vol 4 (2) ◽

pp. 35-40

Author(s):

Nazma Parvin Ansari ◽

AJE Nahar Rahman ◽

AFM Saleh ◽

SM Shahida

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Developed Countries ◽

Cervical Lesion ◽

Histopathological Diagnosis ◽

Age Group ◽

Cervical Lesions ◽

Screening Programs ◽

Medical College ◽

Gynecology And Obstetrics

Cervical cancer is the second most frequent type of cancer and leading cause of mortality among women worldwide. More than eighty eight percent deaths from cervical cancer occur in developing countries and by 2030, it will be at least ninety eight percent. In developed countries, the cases and deaths have declined markedly due to their extensive screening programs. The present study was undertaken to assess precancerous and cancerous cervical lesion by cytology and their comparison with histopathology in VIA positive cases. This descriptive, cross-sectional type of observational study was carried out in the Department of Pathology, Mymensingh Medical College in collaboration with the Department of Gynecology and Obstetrics, Mymensingh Medical College Hospital, during the period of July 2012 to June 2013. Study was carried out among 160 VIA positive patients and selected by non-random judgment sampling from the colposcopy clinic. Histological findings revealed that the most common age group affected by different types of cervical lesions is 30 – 39 years. It also revealed that squamous cell carcinoma (SCC) was very much common in age group 40-49 years. The statistical value of accuracy, sensitivity and specificity of Pap smear cytology test and histopathology yielded some important directives. The sensitivity values of Pap smear cytology was found 87.50%. The accuracy of the Pap smears in this study was 88.13%. The present study show significant relationship between cytological test with histopathological diagnosis. However cytology testing is not suitable as a single test. In conclusion, it can be stated that combination of cytology (Pap smear) and histopathology would ultimately be more useful. CBMJ 2015 July: Vol. 04 No. 02 P: 35-40

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Investigating Cervical Lesion and Human Papillomavirus in Apparently Healthy Religious Women in Benin City, Nigeria

Nigerian Journal of Technological Research ◽

10.4314/njtr.v15i2.6 ◽

2020 ◽

Vol 15 (2) ◽

pp. 36-42

Author(s):

E.B. Odigie ◽

S.O. Bolaji-Osagie

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Uterine Cervix ◽

Cervical Lesion ◽

Low Grade ◽

Age Group ◽

Cervical Lesions ◽

Religious Women ◽

Benin City ◽

Pentecostal Churches

Pathological abnormalities observed in cells or tissues obtained from the uterine cervix of women are collectively referred to as cervical lesions. The condition is gradually becoming a menace as it can affect different category of women. It is more worrisome as religious women particularly are not spared from the deadly scourge. This study was to investigate cervical lesion and human papillomavirus in relatively healthy religious women attending Pentecostal churches in Benin City, Nigeria. A cross-sectional investigation of the participants using structured questionnaire and the liquid-based cytology from January to July 2017 was used as the data and sample collecting tools. Majority of religious women that participated in the survey (n=429) cut across 47 Pentecostal churches. The mean age of the respondents was 48.46years (±2SD) with the highest number of participants being age group (36-45years) 131/429(31%), and ≥66years 13/429(3%). HPV infection was 9/429(2.1%), and the worst hit was among age group (26-35years) 5/429(1.2%) followed by 3/429(0.7%) amongst age group 36-45years, and 1/429 (0.2%) from age group 46-55years. 51/429(11.89%) was cervical lesion positive, while cytopathology revealed inflammatory smears (acute and chronic cervicitis), atypical glandular cells (AGC), low-grade squamous cell intraepithelial lesions (LSIL), and atypical squamous cells of undetermined significance (ASCUS). Cervical lesion and subsequent HPV infections are prevalent within the study population. However, to avert the impending dangers (cervical cancer) posed by cervical lesions in the society, modesty in sexual exploitation and decent lifestyles are highly imperative. Keywords: Cervical cancer, Cervical lesion, Uterine cervix, Uterine infections, Religious women.

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High-risk HPV genotypes and cervical lesions association in postmenopausal women

European Journal of Public Health ◽

10.1093/eurpub/ckab120.044 ◽

2021 ◽

Vol 31 (Supplement_2) ◽

Author(s):

Ana Rita Fernandes Miranda da Costa ◽

Cláudia Sousa ◽

Erica Isidoro ◽

Regina Silva ◽

Cristiana Mourato

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Postmenopausal Women ◽

Age Groups ◽

Low Grade ◽

High Grade ◽

Cervical Lesions ◽

Intraepithelial Lesion ◽

The Bethesda System ◽

High Risk Hpv

Abstract Background Persistent infection by high-risk Human Papillomavirus (hrHPV) are the major cause of cervical cancer. Studies report disparities in the incidence of infection and the various genotypes of this virus in different age groups, suggesting a higher frequency of hrHPV in young women and low-risk subtypes being predominant in older women. This study aimed to investigate the incidence and distribution of hrHPV genotypes in postmenopausal women as well as the correlation with the cytological findings. Methods 16 859 women, aged 50–64 years, performed cervical cancer screening test in Friuri Venezia Giulia region, Italy. The infection was evaluated by the Polymerase Chain Reaction methodology and the positive samples were evaluated by Liquid Based Cytology according to the Bethesda System from 2014. A statistical analysis was performed to study the molecular and cytological data of this population. Results hrHPV infection were found in 5.8% of the women and 78.3% of these were caused by hrHPV other than HPV16 and HPV18 (). Also, 65.7% of the positive samples were negative for intraepithelial lesion or malignancy while low grade squamous intraepithelial lesion was the most frequent (22.4%). There was an increase in the number of high-grade intraepithelial lesions in the presence of HPV16 compared to that recorded when this genotype was absent (20.8% vs. 8.5%). No cervical cancers were detected. Conclusions Infection with hrHPV is uncommon in postmenopausal women and it is mostly caused by subtypes less associated with the development of cervical cancer. Yet, HPV16 infection triggers the development of high-grade lesions.

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Immunohistochemical expression of p16INK4A in the lesions of uterine cervix

Annals of Pathology and Laboratory Medicine ◽

10.21276/apalm.2880 ◽

2020 ◽

Vol 7 (10) ◽

pp. A502-508

Author(s):

Niharika Rawat ◽

Shivapriya Rajan

Keyword(s):

Cervical Cancer ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Intraepithelial Neoplasia ◽

Low Grade ◽

High Grade ◽

Cervical Lesions ◽

Cancer Management ◽

Squamous Intraepithelial Neoplasia

Background: Cervical cancer is the major cause of cancer deaths among women. Globally, around 5,70,000 new cases of cervical cancer and 3,11,000 deaths occurred in the year 2018. In India, Cervical cancer is a leading cause of cancer related mortality among women and the number of deaths is 60,000 per year among 97,000 diagnosed patients, especially those from lower socioeconomic group. Human Papilloma Virus (HPV) plays a crucial role in causing cervical dysplasia. This is done by upregulating p16INK4A, a cyclin dependent kinase inhibitor through interaction with cellular regulatory proteins. Hence p16INK4A can be used as a biomarker, since it is directly related variable for the presence of HPV. This study was conducted to evaluate the expression of p16INK4A in benign, premalignant and malignant cervical lesions and to assess its utility in diagnosing and grading cervical lesions. Methods: A total of 80 cervical specimens categorized histopathologically into nonspecific cervicitis, low grade squamous intraepithelial neoplasia (LSIL), high grade squamous intraepithelial neoplasia (HSIL) and squamous cell carcinoma cervix were included in this prospective study of one-year duration. Immunohistochemical study of p16INK4A were interpreted qualitatively and semi-quantitatively by Allred scoring system (0 to 8 points) which measures the proportion of stained cells and intensity of staining of cells. The collected data were statistically analyzed by ANOVA and chi square test. Result: Qualitative method showed absence of p16INK4A expression in all nonspecific cervicitis. 16.7% (2/12) LSIL, 100% (12/12) HSIL and 100% (28/28) squamous cell carcinoma cases showed p16INK4A positivity. Allred scoring of p16INK4A showed 66% (8/12) HSIL and 85.7% (24/28) squamous cell carcinoma cases with score 3 positivity. Hence high-grade lesions showed higher expression of this marker. Conclusion: IHC expression of p16INK4A showed increasing degree of expression from benign to premalignant and malignant lesions suggesting its diagnostic and prognostic value in the cervical cancer management

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Immunohistochemical expression of p16ink4a in inflammatory, preneoplastic and neoplastic cervical lesions

Medicinski pregled ◽

10.2298/mpns1504085g ◽

2015 ◽

Vol 68 (3-4) ◽

pp. 85-92

Author(s):

Radoslav Gajanin ◽

Zivorad Gajanin ◽

Zoran Vujkovic ◽

Vesna Gajanin ◽

Zdenka Gojkovic ◽

...

Keyword(s):

Cervical Cancer ◽

Surrogate Marker ◽

Immunohistochemical Analysis ◽

Human Papillomaviruses ◽

Low Grade ◽

Main Role ◽

High Grade ◽

Cervical Lesions ◽

Inflammatory Lesions ◽

Significant Difference

Introduction. High-risk human papilloma viruses play a main role in the development of cervical dysplasias and carcinomas. p16INK4a can be considered as a surrogate marker of active highrisk human papillomaviruses infection in dysplastic and neoplastic cells of the cervix. This study was aimed at determining the presence and level of p16INK4a expression in inflammatory, preneoplastic and neoplastic lesions of the cervix. Material and Methods. The study was performed on 109 samples of cervical biopsy. Cervical cancer was diagnosed in 36 patients, 34 patients had a preneoplastic change (dysplasia) in stratified squamous cervix epithelium and a nonspecific inflammatory process was found in 39 patients. In all samples, immunohistochemical analysis using antibodies to p16INK4a was performed. Results. The expression of p16INK4a was verified in all cases of cervical cancer (100%), in 67.65% of dysplastic cervical lesions and in 38.5% of inflammatory lesions. A statistically highly significant difference was found in the presence and level of expression among neoplasic, dysplastic and inflammatory lesions of the cervix (?? = 76.02, p < 0.001). The expression was more frequent and had a higher level in neoplastic and high grade dysplastic lesions compared to expression in inflammatory lesions and low grade dysplasias. Conclusion. The analysis of the presence of p16INK4a can differentiate non-neoplastic, high grade preneoplastic and neoplastic changes of the cervix. The use of p16INK4a in interpreting borderline lesions of the cervix can enable a rational therapeutic treatment of patients.

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Correlation of hTERT Expression with Cervical Cytological Abnormalities and Human Papillomavirus Infection

PRILOZI ◽

10.2478/prilozi-2018-0015 ◽

2017 ◽

Vol 38 (3) ◽

pp. 143-151

Author(s):

Vjosa A. Zejnullahu ◽

Valon A. Zejnullahu ◽

Slavica Josifovska ◽

Nikola Vukovik ◽

Kiril Pakovski ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Reverse Transcriptase ◽

Hpv Infection ◽

Cell Phenotype ◽

Transcriptional Level ◽

Low Grade ◽

High Grade ◽

Htert Expression ◽

Cervical Lesions

AbstractTelomerase Reverse Transcriptase (TERT) is the main catalytic sub-unit of telomerase, a reverse transcriptase enzyme. Telomerase expression is regulated at many levels, with numerous studies suggesting that up-regulation of human TERT gene (hTERT) at transcriptional level results in immortal cell phenotype associated with cancer. The aim of this study is to determine the correlation between hTERT expression and different cervical precursor lesions, as well as with cervical cancer in patients with confirmed Human papillomavirus (HPV) infection.The study included molecular analyzes on cervical samples from 214 women and matched Papanicolaou (Pap) test results. HPV detection and genotyping was performed by polymerase chain reaction (PCR) and genotyping. Quantitative real-time PCR (qRT-PCR) was performed using TaqMan probes and were calculated relative to the reference gene.Results showed significantly increased hTERT mRNA expression levels in high-grade and low-grade lesions compared to normal control samples (p<0.01) associated with 6.31 fold higher risk for developing ASC-US and 9.20 for LSIL. Strong correlation between HPV infection and hTERT expression in the high-grade lesions and cervical cancer was also observed. hTERT relative expression values showed 98% specificity and 100 % sensitivity as indicator of cervical lesions particularly for the ACS-H, HSIL and cervical cancer. In conclusion, hTERT expression correlate with the cytological grade of the cervical lesions and HPV infection and has a potential to be used as a diagnostic and prognostic marker.

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HPV Positivity and Risk of Cervical Cancer according to HIV-Infection: A Comparative Assessment in the Population of Cameroonian Women

10.21203/rs.3.rs-279543/v1 ◽

2021 ◽

Author(s):

Samuel Martin SOSSO ◽

Michel Carlos TOMMO TCHOUAKET ◽

Joseph Fokam ◽

Rachel Kamgaing Simo ◽

Ezechiel Ngoufack Jagni Semengue ◽

...

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Hiv Infection ◽

Cervical Lesion ◽

Hiv Positive ◽

Low Grade ◽

Cervical Lesions ◽

Epithelial Lesion ◽

Oncogenic Hpv ◽

Hiv Negative

Abstract Background Cervical cancer, caused by the human papillomavirus (HPV), remains a global health challenge. In HIV highly-burdened settings, it would be relevant to understand the severity of cervical cancer in case of co-infection with HPV. We therefore sought to determine the effect of HPV on the occurrence of cervical lesions among women with versus without HIV-infection. Methods A cross-sectional analytical study was conducted throughout 2012 among 257 women living in Yaoundé, Cameroon. HIV serology, genotyping of high-risk oncogenic HPV and cervical vaginal smear (CVS) were performed for all participants; among those reported to be HIV seropositive, HIV plasma viral load and CD4 count were measured. Results of the CVS were interpreted following the Bethesda 2001 guidelines. Statistical analyses were performed using Graph Pad version 6.0; p < 0.05 was considered statistically significant. Results The mean age of our study participants was 37 ± 6.5 years. According to HIV serology, 184 (71.59%) were HIV-positive vs. 73 (28.40%) HIV-negative women, with a similar age distribution respectively (36 ± 2.80 years versus 42 ± 8.48 years). Among HIV-positive women, median CD4 was 438 [IQR: 317–597] cells/mm3 and median viremia < 40 [IQR: <40 − 2318] copies/mL. Following successful genotyping, the prevalence of high-risk oncogenic HPV was 36.32% (73/201), with a significantly higher proportion among those with HIV-infection (41.98% [55/131] vs. 25.71% [18/70]; p = 0.02; OR = 2.1). CVS revealed 31.74% (97) normal cervix; 38.91% (100) inflammation; 16.34% (42) low-grade squamous intra-epithelial lesion; 6.34% (18) high-grade squamous intra-epithelial lesion. Overall rate of cervical lesions was 23.34% (60/257), with a non-significantly higher proportion in HIV-infected participants (25.00% [46/184] versus 19.17% [14/73]; p = 0.31). Of relevance, the presence of high-risk oncogenic HPV was significantly associated with cervical lesions (p < 0.0001; OR = 5.07), with a higher risk of cervical lesion among HIV-positive (p < 0.0001 and OR = 5.67) versus HIV-negative (p = 0.03 and OR = 3.83). Conclusion Though oncogenic HPV appears as an independent factor of the occurrence of cervical lesions, the risk of cervical lesion is substantially higher among HIV/HPV co-infection compared to HPV-infection alone. Thus, prevention of cervical cancer should be prioritised for women living with HIV-infection in HPV-endemic settings.

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HPV16 E7 Oncoprotein As a Predictor of Diagnosis and Prognosis in Patients with Cervical Lesions

10.21203/rs.3.rs-135596/v1 ◽

2020 ◽

Author(s):

Guangnan Shuai ◽

Junhui Xu ◽

Meihua Liu ◽

Xueping Zhu ◽

Na Zhang ◽

...

Keyword(s):

Cervical Cancer ◽

Critical Value ◽

Cervical Lesion ◽

Pathological Examination ◽

Low Grade ◽

Squamous Intraepithelial Lesions ◽

Cervical Lesions ◽

E7 Oncoprotein ◽

The Third ◽

Intraepithelial Lesions

Abstract Backgroud：The early diagnosis and treatment of HSIL is a key measure to prevent the occurrence of cervical cancer. Although the methods of cervical cancer screening are becoming more and more abundant, some patients still have unnecessary colposcopy referrals. This study aim to explore the value of human papillomavirus 16 (HPV16) E7 oncoproteinin cervical lesion screening and risk assessment of the prognosis for more effective colposcopy. Method: HPV16 E7 oncoprotein in cervical exfoliated cells was detected by using E7 Oncoprotein (HPV16) Diagnostic Kit (Magnetic Partical Chemiluminescence Method). In the first part, HPV16 E7 oncoprotein in different degrees of cervical lesions was retrospectively compared to find the best critical value; In the second part, the value of this test was verified ; In the third part, the women diagnosed as low-grade squamous intraepithelial lesions (LSIL) or normal were followed up for 3 years and the outcomes were compared. Results: In the first part, the expression of HPV16 E7 oncoprotein was positively correlated with the degree of cervical lesion; The critical value determined by ROC curve is 8.68ng/ml, which is accurate in the diagnosis of high-grade squamous intraepithelial lesions (HSIL) and invasive carcinoma of cervix (CA); In the second part, there were higher sensitivity(87.1) and specificity(70) for E7 oncoprotein; HPV16 E7 oncoprotein has higher consistency with pathological examination in detection of HSIL or cervical cancer（0.573 vs 0.369) than TCT; In the third part，HPV16 E7 oncoprotein has a high positive predictive value (82.4%) and positive likelihood ratio (4.43) for the prognosis of patients with LSIL and below. Conclusions: The status of HPV16E7 oncoprotein shows important clinical value for the detection and prediction of cervical lesions. Patients with positive HPV16 E7 oncoprotein are more likely to develop the disease and have a higher risk of disease progression.

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Detection of gene amplification in MYCN, C-MYC, MYCL1, ERBB2, EGFR, AKT2, and human papilloma virus in samples from cervical smear normal cytology, intraepithelial cervical neoplasia (CIN I, II, III), and cervical cancer

Colombia Medica ◽

10.25100/cm.v42i2.765 ◽

2011 ◽

pp. 144-153

Author(s):

Dabeiba Adriana García ◽

Ignacio Briceño ◽

Marcos Castillo ◽

Fabio Ancizar Aristizábal

Keyword(s):

Cervical Cancer ◽

Gene Amplification ◽

Intraepithelial Neoplasia ◽

Low Grade ◽

High Grade ◽

Cancer Genes ◽

Cervical Lesions ◽

Normal Cytology ◽

Papilloma Virus ◽

Cin Iii

Introduction: Cervical cancer is the second most common cancer among women worldwide and the second cause of cancer mortality in women. It has been demonstrated that the process of cervical carcinogenesis displays genetic and environmental epigenetic components. Currently, research is focused on new prognosis markers like oncogene amplification. Objectives: To perform detection of MYCN, C-MYC, MYCL1, ERBB2, EGFR, and AKT2 amplification. Additionally, to detect human papillomavirus in samples from normal cytology smear, cervical intraepithelial neoplasia (CIN) I, II, and III and cervical cancer patients. Methods: Papillomavirus (HPV) genotyping by reverse line blot (RLB) performed and gene amplification by detection with real-time PCR with Taqman probes. Results: HPV was present in 4% of the patients with normal cytology, 48% in CIN I, 63.6% in CIN II, 64% in CIN III, and 70.8% in cervical cancer. Genes amplified in cervical cancer were MYCN (39.1%), ERBB2 (34.7%), and MYCL1 (30.4%); showed higher amplification in high-grade lesions and cervical cancer in relation to low-grade lesions and normal cytology with statistically significant differences. Besides the genes, C-MYC, EGFR, and AKT2 were amplified in samples from patients with cervical cancer by 12%, 18%, and 13%, respectively; we did not find statistical differences. Conclusion: Higher prevalence of gene amplification and HPV was found in high-grade cervical lesions and cervical cancer.

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A Descriptive Review of the Community-Based Cervical Cancer Screening Programme at the Singapore Cancer Society

Journal of Global Oncology ◽

10.1200/jgo.18.37600 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 52s-52s

Author(s):

B. Srilatha ◽

Q. Huang ◽

M.S. Hafidza ◽

N.K. Asarpota

Keyword(s):

Cervical Cancer ◽

Pap Smear ◽

Past History ◽

Large Population ◽

Screening Method ◽

High Grade ◽

Cervical Lesions ◽

Papanicolaou Test ◽

Community Based ◽

Human Papillomavirus Vaccination

Background: Cervical cancer is the fourth common malignancy in women worldwide and clinical Papanicolaou (Pap) smear test is a relatively inexpensive yet efficacious screening method for the detection of precancerous or cancerous lesions. Aim: Herein, we sought to quantify the incidence and prevalence of abnormal cervical cytology in asymptomatic women who underwent routine Papanicolaou test screening at the community-based clinical setting of our Singapore Cancer Society's Multi-Service Centre. Methods: This retrospective study reviewed a total of 15,195 reports of cervical Pap smears performed from January 2015 to December 2017 to delineate epithelial abnormalities. Additionally, a descriptive cross-sectional analysis was carried out on the corroborative demographic and clinical data retrieved from the relevant case notes. Results: The mean age of women recruited for screening in this period was 49.0 ± 11.1 years. A total of 623 (4.1%) were identified with abnormal Papanicolaou test results viz., i. atypical squamous/glandular cells of undetermined significance (n=592; 3.9%), ii. low/high grade squamous intraepithelial lesions (n=28; 0.18%) and iii. high grade squamous intraepithelial lesion, suspicious of squamous cell carcinoma/adenocarcinoma (n=3; 0.02%). Clinical history in the latter two cohorts (n=31; 0.2%) revealed first sexual encounter at age ≤ 20 years (54.8%), ≥ 2 sexual partners (38.7%) or abnormal vaginal discharge (29.0%). An 80.6% and 6.5% had undergone Papanicolaou test or HPV - human papillomavirus - vaccination in the past. History of smoking, long-term contraceptive use and treatment of STI(s) were reported by 22.6%, 3.2% and 6.5% respectively. Conclusion: Cervical cancer originates in the transformation zone of the uterine cervix and screening for abnormal cytology is the cornerstone in early detection. The low percentage of epithelial cell abnormality identified in this large population sampling over three years confirms that routine Papanicolaou test testing would suffice as a cost-effective screening approach to detect precancerous cervical lesions. Where imperative, necessary follow-up on unsatisfactory Papanicolaou test result(s), HPV genotyping and/or due referral procedures would significantly aid in reducing the cervical cancer burden for women in the susceptible age range.

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