The incidence of significant lesions on the cervical smears in women under 30 years of age in Cape Town

Dr Genevieve Warner Learmonth, FF Path Anat (SA)Sharon Fenwick CTIACDr Despina Learmonth, D Psych*Nicholas Low, Medical Student

Yvonne Parfitt Cancer Research Cytology Laboratory, NHLS Groote Schuur Hospital, and *Department of Psychology, University of Cape Town, South Africa

Cervical Cancer in South Africa In South Africa asymptomatic

women under 30 years are not offered a free cervical smear.

Invasive Cervical Cancer (ICC) is the second most common cancer in SA.

Recent figures: Lifetime risk of developing ICC is 1:31 for SA women.

60% of these will die from this easily preventable disease

History of Guidelines for cervical screening in South AfricaIn 2001 it was argued that cervical screening at 3 year intervals from time of sexual debut was impractical: healthcare resources could be better spent on screening high risk groups only.

This, despite a report in 1990 of a peak incidence of CIN3 ( HSIL) and ICC in women aged 20-30 years.

Current National Screening Policy: a free smear at age 30, 40 and 50 years of age

Young women in South Africa Age of sexual debut amongst women in SA is

16.9 yrs.They are at risk for sexually transmitted

infections including Human Papilloma Virus and HIV.

HPV is critically linked to the development and progression of pre-invasive cancerous lesions of the cervix. 21% of SA women are HPV positive.

The peak incidence of HIV infection in SA is in women aged 25 -29. HIV destroys immune function facilitating persistence of infections.

HIV intensifies progression from HSIL to ICC.

METHOD

Data on cervical smears from the computerised records at Groote Schuur Hospital Cytopathology Laboratory for 2009 to 2011 inclusive:

Total & age specific prevalence of women who had a cervical smear were calculated.

The number of women who were referred to Colposcopy for treatment of suspicious lesions, HSIL, and 3 consecutive LSIL.

The incidence of HIV infection in this group of women is unknown.

Results Total smears in 2009-2010: 108,542 Total Women under 30yrs: 23,317

(21%)

Total Women ref. to Colposcopy: 3,080 Total Women under 30yrs to Colp: 577

(19%)

COLPOSCOPY INCIDENCE Women 30yrs and older: 28 per 1000 smearsWomen under 30yrs: 25 per 1000 smears

ResultsTotal smears

in 2009-2010

108,542

Total under 30 yrs

23,317

Total over 30 yrs

85,225

Women referred for ColposcopyTotal

referred to Colposcopy:

3,080

Total under age 30yrs:

577

Significant lesions on smears in the UK, for comparison with Cape Town

Economic and psychosocial impactThe overall psychosocial and early impact of preventable

invasive cancer of the cervix is considerable:

Five year survival for women with ICC is: Stage I :80% Stage II: 50%, Stage III: 30% Stage IV:

15% The higher the clinical stage the more radical the

surgery and prolonged the radiotherapy, results in considerable morbidity with risk of recurrence.

Loss of employment and reproductive functionLoss of young mothers with school going children Motherless children do not gain equal education as

their peers, and so enter the cycle of poverty.

ConclusionThese results from GSH in South Africa suggest

that “first time” cervical screening at 30 years could be too late to identify many young women with HSIL and ICC

Currently disadvantaged women are not invited for free screening before the age of 30yrs despite all the predisposing factors and documented evidence of the alarming risk of morbidity and mortality from this preventable cancer in young women.

An urgent review of the National Guidelines for Cervical Screening is imperative.