Cervical cytological services in the Orange Free State. Demographic characteristics

In the Bloemfontein academic hospitals the incidence of infiltrating cervical cancer is four times that of severe cervical intra-epithelial neoplasia (CIN III). A cross-sectional survey was therefore conducted to identify the extent of cervical cytological services in the Orange Free State. From the four major laboratories dealing with the population of the OFS all cytological reports of one randomly chosen working day per month in 1985 were analysed for three demographic variables: age, race, and locality according to census district. As a control, similar demographic variables were identified from national census figures for 1980, limited to females aged 15-65 years. The follow-up of patients with CIN III diagnosed cytologically in the academic hospitals in Bloemfontein was determined. Results showed significant differences (P less than 0.001) in age, race and locality between the census population and that submitted to cytological screening. Acceptable figures were virtually limited to Bloemfontein, predominantly in white patients, while three-quarters of the population of the OFS is black. The peak frequency in the age distribution in the screened population was 25-35 years and 15-24 years for the census population. Follow-up for patients with CIN III was 65.5%. The conclusion is that the female population of the OFS is not representatively reached by existing cytological services.