Screening for cervical neoplasia in Mamelodi--lessons from an unscreened population

To determine the prevalence of abnormal cervical cytological findings in an unscreened population; to assess patients' awareness of cervical cancer and the importance of early diagnosis; and to evaluate the accuracy of visual inspection of the cervix as a screening method for asymptomatic cervical cancer.

Descriptive.

Mamelodi Hospital, a community day hospital east of Pretoria, serving a black urbanised population that had never been exposed to a routine cervical cytological screening programme.

One thousand and ninety-five women of reproductive age, who presented with a non-gynaecological complaint, were offered cervical cytological testing and were asked to complete a questionnaire. Visual appreciation of the cervical condition was noted and compared with the cytology report.

The prevalence of abnormal cervical cytological findings (low- and high-grade squamous cervical intra-epithelial neoplasia (CIN), excluding human papillomavirus-induced cell changes only) was 54/1,000. Only 2% of the patients had a good knowledge of cervical cancer and cervical screening. Visual inspection of the cervix detected 4 out of 5 cervical cancers in this group, but failed to identify those patients with high-grade CIN.

This study shows a high prevalence of abnormal cervical cytological findings in a population ignorant about cervical cancer. Recommendations on how to improve this situation are made.