Rubia Noreen, Huma Qudussi


Background: Cervical intra-epithelial neoplasia (CIN) and cervical cancer remain important health
problems for women worldwide. It is largely a preventable disease that is characterised by a long lead
time. The objective of this study was to determine the frequency of precancerous conditions of cervix
(CIN I–III) in women with chronic vaginal discharge by Pap smear screening. Methods: The study was
conducted at the outpatient department of Obstetric and Gynaecology, Nishtar Hospital Multan, and
Multan Institute of Nuclear Medicine & Radiotherapy (MINAR) from February 2009 to February 2010.
Two hundred and eighty patients with complaint of chronic vaginal discharge were selected. Their
detailed history was documented on a Proforma, Pap smear taken at MINAR, and samples sent to
pathology department of Nishtar Hospital Multan for cytological examination. All mild dyskaryosis or
CIN I cases were advised follow-up with repeat Pap smear in 6–12 months and those with moderate to
severe neoplasia (CIN II–III) were further investigated by cervical biopsy and managed accordingly.
Results: Of the total, 100 patients were between 25–30 years of age, and 180 between 31–35 years of
age. Mean age of patients was 31.6 years, mean age at marriage 21.7 years, and mean parity was 3.6.
Most of the patients (67.9%) belonged to low socioeconomic status. The cytological examination of the
smears showed no changes (normal) in 100 (35.7%) cases, while 156 (55.7%) cases showed
inflammatory changes, 10 (3.6%) showed dysplastic changes, of whom 8 cases had CIN-I (2.8%) and
one case was of CIN-II (0.4%). One was having CIN-III/severe dysplasia (0.4%). Inadequate sample was
reported in 14 (5%) cases. Conclusion: Pap smear should be used as a routine test for all sexually active,
young females presented to the gynaecology outpatient department, for early detection of cervical pre
cancer (CIN) as it is not uncommon in our set up.
Keywords: Pap smear, Cervical Intraepithelial Neoplasia, CIN, cervical, Screening Program

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