Objective: To determine the incidence of pre invasive and invasive cervical lesions and also cost- effectivenessof Pap smears in Kermanshah, Iran (2004-2007). Methods: A descriptive, cross sectional study was performedbetween March 2004-March 2007 with all cytological smears analyzed according to the Bethesda II system.Efficacy was estimated as the ratio of HSIL and invasive carcinomas detected to all Pap smears. Data wereanalyzed with SPSS software and mean±SD for cost in each age. Results: 148,472 smears were analyzed ofwhich 99.7 % were negative, only 0.3% having cytological abnormalities. ASCUS, LSIL, HSIL and carcinomapositive rates were 205.4, 73.4, 21.6 and 5.4 per 100,000 Pap smears respectively. The incidence of HSIL andcarcinoma in total was 26.9 per 100,000 women. Before age 35 there were no such lesions so that the effectivenessof Pap smear before age 35 was zero. The cost for one smear was 5 Euros and the cost for detection per HSIL orcarcinoma was 18,559 Euros. The mean age of women for HSIL was 52.0±10.7 and for carcinoma 48.1±1.81years. Conclusions: Since no HSIL or carcinomas were detected before age 35, and since for changing one LSILto HSIL or carcinoma should take more than 5 years , the results of this study suggest that Pap smears before 35years old is not effective and we suggest commencement of Pap smear in Iran from age 30.
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