Diagnostic Efficacy of Pap Smear in Early Detection of Cervical Cancer among Women

 

Ms. Shakila1, Dr. S. Rajasankar2, Dr. N. Kokilavani3

1Professor, Adhiparasakthi College of Nursing Melmaruvathur

2Professor, Research Guide, Velammal Medical College Hospital And Research Institute Madurai

3Research Co guide, Adhiparasakthi College of Nursing. Melmaruvathur

*Corresponding Author E-mail: shakilaobg@gmail.com

 

ABSTRACT:

Women age 21-69 were subjected to pap smear for early detection of cervical cancer the objective of the study to determine the diagnostic efficacy of pap smear among women. Quantitative research approach was used, with cross sectional research design was used. Convenient sampling technique was used. The result shows that pap smear sensitivity 100%, specificity 95%, false negative rate o% and false positive rate 0.04%.

 

KEY WORDS: Diagnostic efficacy , Pap smear and Cervical cancer

 

 


INTRODUCTION:

Cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases in 2012. There were an estimated 266,000 deaths from cervical cancer worldwide in 2012, accounting for 7.5% of all female cancer deaths. Almost nine of 10 (87%) cervical cancer deaths occur in the less-developed regions. Mortality varies 18-fold between the different regions of the world, with rates ranging from less than 2 per 100,000 in Western Asia, Western Europe and Australia/New Zealand to more than 20 per 100,000 in Melanesia (20.6/100,000) and Middle (22.2/100,000) and Eastern (27.6/100,000) Africa.1

 

STATEMENT OF THE PROBLEM:

Diagnostic efficacy of papsmear in early detection of cervical cancer among women.

 

OBJECTIVE:

To detect premalignant lesion of cervical cancer among women.

To determine the diagnostic efficacy of pap smear in early detection of cervical cancer.

 

RESEARCH METHODOLOGY:

Research methodology is a system of models procedures and techniques used to find the result of research problems. The success of the any research depends largely upon the suitability of the tools and the technique that the researcher follows to gather adequate data. Research methodology involves systematic procedure which the research starts from initial identification of the problem to its final condition. The role of methodology consists of procedures and techniques for conducting a study.

 

This chapter deals with description of the methodology adopted by the researcher. It includes research design setting of the study, population, sample, sample size, sample technique criteria for sample selection, description of the instrument data collection procedure and plan for data analysis.

 

RESEARCH Design:

Cross sectional research design was utilized .

 

SETTING OF THE STUDY:

The study was conducted in Melmaruvathur, Adhiparasakthi Institute of Medical Sciences and Research Melmaruvathur, Kancheepuram district.

 

POPULATION:

The Population consists of all women residing at Melmaruvathur.

 

SAMPLE:

The sample consists of mothers those who attend the gnaec out patient department and who fulfill the inclusion criteria

 

SAMPLE SIZE:

The sample size consists of 50 mothers who attend the gynaec out patient department.

 

SAMPLING TECHNIQUE:

Convenient sampling technique was used to select the mothers with inclusion criteria.

 

CRITERIA FOR SAMPLE SELECTION:

Inclusion Criteria:

All women age 21 and above

 

Exclusion Criteria:

·      The women with cervical cancer

·      Women who had underwent total hysterectomy

·      Women aged ≥ 70 years

·      Women who had three or more normal Pap test and no abnormal Pap test report in last 10 years.

 

DESCRIPTION OF THE INSTRUMENT:

The instrument was developed after the literature review and guidance from the experts. In consists of two Parts: 

Part – I:

It Consists of demographic variables such as, age, religion, education, occupation and income.

 

Part – II:

It consists of reproductive history of women

 

Part – III:

It consist of early detection of cervical cancer among women attending Gnaec outpatient department who fulfill the inclusion criteria. Pap smear was used as diagnostic procedure in early detection of cervical cancer.

 

VALIDITY:

The content validity of the instrument was obtained from the experts in the field of obstetrics and gynaecology. Simplification of the language and reorganization of certain items were made as per the experts suggestions.

 

ETHICAL CONSIDERATION:

The study was conducted after the approval of dissertation committee. The women were explained about the study purpose. The formal written consent was taken from the samples. The usual assurance of anonymity and confidentiality was obtained.

 

A formal written permission from the concerned authorities and a written consent from the women were obtained

 

METHODS:

A complete history of the patient pertaining to complaints, any white discharge per vagina, post coital bleeding, previous Pap smears obstetric history, menstrual history, contraception history is obtained. Informed written consent is taken. Detailed clinical data was obtained and noted on a structured proforma per speculum examination of cervix and vagina was done. The squamo columnar junction was visualized, with Ayer’s Spatula squamocolumnar junction was craped gently throughout circumference and material was transferred to glass fixed with 95% alcohol immediately and stained by papanicolaou stain.

 

Frequency and percentage of demographic variable

 

Sl. No

Demographic variables

Number

%

1.

Age in years

a.       21-27

 

5

 

10%

b.       28-37

18

36%

c.       38-47

18

36%

d.       48-57

7

14%

e.       58-69

2

4%

2.

Education status

a.       Illiterate

 

22

 

44%

b.       Primary school

14

28%

c.       Secondary school

12

24%

d.       Graduate

2

4%

3.

Occupation

a.       Home maker

 

37

 

74%

b.       Business

-

-

c.       Employed

13

26%

4.

Family income

a.       Below Rs.3000

 

16

 

32%

b.       3001 to 4000

18

36%

c.       4001 to 5000

11

22%

d.       5001 to above

5

10%

5.

Religion

a.       Hindu

 

44

 

88%

b.       Muslim 

6

12%

c.       Christian

-

 

d.       Others

-

 

6.

Marital status

a.       Unmarried

 

-

 

-

b.       Married

42

84%

c.       Widow

8

16%

 

DATA ANALYSIS:

The data was analyzed in terms of the objectives of the study using descriptive and inferential statistics. Demographic variables of women were analyzed in terms of frequency percentage.

 

REPRODUCTIVE HISTORY  

1.        

 

 

Age at  menarche

a.       13-15

 

42

 

84%

b.       16-18

8

16%

 

2.        

 

Age at marriage .

a.       <18

 

4

 

8%

b.       ≥18-23

34

68%

c.       24-29

12

24%

d.       30-35

-

-

e.       36-40

-

-

3.        

Age at 1st intercourse

a.       <18

 

4

 

8%

b.       ≤18

6

12%

c.       19

14

28%

d.       20

6

12%

e.       21

4

8%

f.        22

4

8%

g.       Above 24

12

24%

4.        

Age at first delivery

a.       18-22

 

38

 

76%

b.       23-27

12

24%

c.       Above 27

-

-

5.        

No.of.children

a.       1 child

 

-

 

-

b.       2 children

14

28%

c.       3 children

12

24%

d.       Above 4 children

24

48%

6.        

Clinical symptoms

a.       Asymptomatic

6

12%

b.       Symptomatic

42

84%

7.        

Awareness of Malignancy

a.       Yes

3

6%

b.       No

47

94%

8.

 

 

 

9.

Menstrual History 

a.       Reg.28 day cycle

29

58%

b.       Irregular cycle

21

42%

History of any infectious disease

a.       Yes

3

6%

b.       No

47

94%

10.

Papaniculou smear

a.       Satisfactory

48

96%

b.       unsatisfactory

2

4%

11.

Pre-marital / Extra marital exposure

a.       Yes

 

-

 

-

b.       No

50

100

 

Application of bayes theorem in determining diagnostic efficacy

Subject classified according to disease status and test result.

 

Papsmear test

Pap Test

Disease

Total

+

+

 

+(5)

3

2

5

  (45)

Nil

45

45

Total

 

 

50

 

 

Sensitivity  TPR : True Positive Rate

Sensitivity :

=

a

=

3

=

3

=

1

a+c

3+0

3

 

Specificity : True Negative Rate

Specificity :

=

b

=

45

=

45

=

0.957

b+d

2+45

47

 

False Negative Rate : (FNR)

 

=

c

=

0

=

0

=

0

a+c

3+0

3

 

False positive Rate (FPR)

Sensitivity :

=

b

=

2

=

2

=

0.042

b+d

2+45

47

 

RESULT:

The study result showed that five mother was positive for pap smear. Women who are positive were subjected to cervical biopsy . Two  had low grade intra epithelial neoplasia ,one mother had high intra epithelial neoplasia and two mother were negative for cervical cancer.

 

CONCLUSION:

The result showed that 50 women were subjected to pap smear. The result shows that pap smear sensitivity 100%, specificity 95%, false negative rate 0% and false positive rate 0.04%. Supportive study a study was conducted with an aim to compare the sensitivity and specificity of pap smear. Totally 7603, with age group of 30-59  women were subjected to pap smear .convenient sampling technique was used .The result of the study was stated that pap smear sensitivity 87.5% and specificity 98.8%.respectively.2.

 

REFRENCE:

1.       Satyanarayanan s. Asthana et al, “A comparative study of cervical cancer screening.” Department of epidemiology and biostatistics and cyto pathology, Institute of cytopathology and preventive oncology, Nodia, uttar Pradesh.

2.       Ferlay J, Soerjomataram I, Ervik M. Globocan 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency for Research on Cancer, 2013. Availabl from: http://globocan.iarc.fr [Last accessed on 2014 Apr 12].  

 

 

 

 

Received on 28.10.2016          Modified on 04.01.2017

Accepted on 13.01.2017          © A&V Publications all right reserved

Int. J. Adv. Nur. Management. 2017; 5(1): 25-27.

DOI: 10.5958/2454-2652.2017.00006.3