Prevalence of Cervical Pap Smear Epithelial Abnormalities in Iraqi Women and Its Correlation with Histopathology

Cervical carcinoma is the fourth most common malignancy among women worldwide, with a disproportionately high incidence and mortality in developing countries, including Iraq, where 320 new cases and 62 deaths were reported in 2023. Although the Papanicolaou (Pap) smear remains the cornerstone of screening, findings across Arab populations have been inconsistent, underscoring the need for region-specific data. This study aimed to determine the prevalence and patterns of cervical epithelial cell abnormalities and assess the diagnostic accuracy of Pap smears in Najaf, Iraq.

This retrospective, cross-sectional study was conducted over ten years (December 2014-December 2024) and included 3522 cervical Pap smears from women aged 16 to 80 years (mean, 36.97 ± 10.62 years) obtained at a private medical laboratory. Samples were classified according to the 2014 Bethesda System.

Of 3522 samples, epithelial cell abnormalities were identified in 192 (5.45%). Atypical squamous cells of undetermined significance (ASC-US) were the most frequent abnormality (3.78%). The highest prevalence was observed among women aged 40 to 60 years. A strong cytohistopathologic correlation was noted. The Pap test demonstrated a sensitivity of 76.19%, specificity of 80.30%, and overall diagnostic accuracy of 79.31%.

The 5.45% prevalence of epithelial abnormalities, predominantly ASC-US, highlights the ongoing need for active cervical cancer screening programs. The significant concordance between cytologic and histopathologic findings confirms the diagnostic reliability of the Pap smear. Further studies are warranted to characterize local cytologic patterns and identify prevalent HPV genotypes to inform HPV vaccination and targeted prevention strategies.