Prevalence of invasive and pre- invasive cervical lesions in Kermanshah (2003-2007)

Background: Cervical cancer is one of the most important gynecologic diseases. Making the determination of prevalence rate of this clinical condition a prime priority. Objective: To determine the prevalence of pre-invasive and invasive cervical lesions in the city of Kermanshah and also the effective age for Pap smear testing. Methods: A descriptive, cross sectional study was performed between March 2004- March 2007 and all Pap smears (n=148472) were analyzed according to Bethesda II system. The data were analyzed using SPSS and mean and standard deviation tables. Effectiveness was estimated as ratio of number of high grade squamous intraepithelial lesion (HSIL) and invasive carcinoma detected to all Pap smears. Findings: Of total smears, 99.7% were negative and only 0.3% showed cytological abnormalities. The presence of ASCUS, LSIL, HSIL, and carcinoma was calculated at 205.4, 73.4, 21.6 and 5.4 per 100.000 Pap smears, respectively. The incidence of HSIL was 4 times higher than that of carcinoma. Collectively, the incidence of HSIL and carcinoma was 26.9 per 100.000 smears. No HSIL or carcinoma was observed before the age 35. Highest incidence of invasive cervical carcinoma was seen in ages 45-49. Conclusions: There was no HSIL or carcinoma before age 35 hence the starting time for performance of Pap smear among women in Kermanshah is suggested to be around 30 to diagnosis LSIL or ASCUS before changing toward HSIL or carcinoma. Pap smear test is not recommended before the age 30 as it is not cost effective in this age group.