Cervical cancer screening in Bali: a public health issue

Cervical cancer is the most common cancer in women in developing countries. Regarding cervical cancer in Bali, we sought to determine the incidence, to evaluate existing preventive and screening programs, to identify the population being screened, and to examine the methods of testing. The records of the Udayana Teaching Hospital pathology laboratory and Cancer Registry were reviewed, retrospectively. The incidence of cervical cancer in Bali is 7/100,000. There has already been a substantial increase in the number of Papanicolaou tests (PT) from 767 in 1990 to 1,355 in 1992. In 63% of these tests the results were Class II, indicating a need for attention to infection. Cervical intraepithelial neoplasia has a statistically significant increase with age. The number of PT performed peaks in the 35-44 year age group, with a sharp decline thereafter. Fifty-four percent of PT are performed in the capital city, which has only 20% of the female population. Bali Hindu women make up 94% of the female population, but receive only 81% of PT, while Muslim women make up 5% of the population and receive 12% of PT. Seventy-eight percent of PT contain no endocervical cells. There has already been a promising increase in the number of PT performed in Bali. Public health promotion efforts as well as outreach programs should be expanded, perhaps using the Banjar system, to reach older and rural women. Collectors of Pap smears should be instructed on the importance of endocervical sampling.