Single Life Time Cytological Screening in High Risk Women as an Economical and Feasible Approach to Control Cervical Cancer in Developing Countries Like India

In view of funding crunches and inadequate manpower in cytology in developing countries like India, singlelifetime screening for cervical cancer has been suggested. In this study, an attempt was made to identify highrisk groups of women for this screening to make it more effective for early detection. Cytological data werederived from the ongoing routine cervical cytology screening program for women attending Gynaecology OutPatient Department of Queen Mary’s Hospital of K.G.Medical University, Lucknow, India during a span of 35years (April 1971 - December 2005). Cervical smears in a total of 38,256 women were cytologically evaluated.The frequencies of squamous intraepithelial lesions of cervix (SIL) and carcinoma cervix were found to be 7.0%and 0.6%, respectively, in the series. Predisposing factors related to cervical carcinogenesis were analyzed indetail to establish the most vulnerable groups of women for single life time screening. The incidence of SIL andcarcinoma cervix was found to be maximal in women above the age of 40 years irrespective of parity and inmultiparous women (with three or more children) irrespective of age. The incidence of cervical cytopathologieswas significantly higher in symptomatic women, the frequency of SIL being alarmingly higher in womencomplaining of contact bleeding and that of carcinoma cervix in older women with postmenopausal bleeding.It is consequently felt that single life time screening must include the three groups of women delineated above.Such selective screening appears to be the most economical, cost effective and feasible approach to affordablycontrol the menace of cervical cancer in developing countries like India.