open access
Secondary cervical cancer prevention in routine prenatal care — coverage, results and lessons for the future
, 2, 1, 1, 2, 2, 2
Affiliations- Students’ Scientific Group affiliated to 2nd Chair and Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
- 2nd Chair and Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
open access
Abstract
Objectives: Cervical cancer is the fourth most common type of cancer among women worldwide and one of the most common malignancies diagnosed in gravidas. Therefore, routine antenatal Pap smear is such an important examination. The aim of the study was to assess the prevalence of Pap smear performance during prenatal care and to determine possible factors affecting it.
Material and methods: A self-composed questionnaire was distributed among 638 women managed in a tertiary obstetric referral center. 33 questions regarded cervical cancer prevention and risk factors.
Results: 96.9% of respondents had undergone Pap smear and 80.6% had it performed during pregnancy. For 11.5% women Pap smear in pregnancy was the first one in their life. The most common reasons for lack of Pap smear performance were: no subjective need to perform it (40.9%), no doctor’s recommendation (28.6%) and lack of gynecological care (16.3%). Among professionally active women the percentage of those who had not undergone Pap smear during pregnancy was statistically higher (28.5%) than among those who were on sick leave (13.5%) (p = 0.0003). Also, younger women were at risk of less frequent participation in cervical cancer screening
Conclusions: Although performance of Pap smear among surveyed patients was relatively high, there was a significant group of women who had undergone their first test during pregnancy, which makes secondary cervical cancer prevention in prenatal care a useful prophylactic strategy. Special attention should be given to younger and professionally active women.
Abstract
Objectives: Cervical cancer is the fourth most common type of cancer among women worldwide and one of the most common malignancies diagnosed in gravidas. Therefore, routine antenatal Pap smear is such an important examination. The aim of the study was to assess the prevalence of Pap smear performance during prenatal care and to determine possible factors affecting it.
Material and methods: A self-composed questionnaire was distributed among 638 women managed in a tertiary obstetric referral center. 33 questions regarded cervical cancer prevention and risk factors.
Results: 96.9% of respondents had undergone Pap smear and 80.6% had it performed during pregnancy. For 11.5% women Pap smear in pregnancy was the first one in their life. The most common reasons for lack of Pap smear performance were: no subjective need to perform it (40.9%), no doctor’s recommendation (28.6%) and lack of gynecological care (16.3%). Among professionally active women the percentage of those who had not undergone Pap smear during pregnancy was statistically higher (28.5%) than among those who were on sick leave (13.5%) (p = 0.0003). Also, younger women were at risk of less frequent participation in cervical cancer screening
Conclusions: Although performance of Pap smear among surveyed patients was relatively high, there was a significant group of women who had undergone their first test during pregnancy, which makes secondary cervical cancer prevention in prenatal care a useful prophylactic strategy. Special attention should be given to younger and professionally active women.
Keywords
cervical cancer; pap smear; prenatal care; pregnancy; secondary prevention
About this articleTitle
Secondary cervical cancer prevention in routine prenatal care — coverage, results and lessons for the future
Journal
Issue
Article type
Research paper
Pages
396-402
Published online
2019-07-26
Page views
2002
Article views/downloads
1078
DOI
Pubmed
Bibliographic record
Ginekol Pol 2019;90(7):396-402.
Keywords
cervical cancer
pap smear
prenatal care
pregnancy
secondary prevention
Authors
Karolina Kuczborska
Joanna Kacperczyk-Bartnik
Marta Wolska
Monika Pluta
Pawel Bartnik
Agnieszka Dobrowolska-Redo
Ewa Romejko-Wolniewicz
References (29)- Ferlay J, Colombet M, Soerjomataram I. et al.. Global and Regional Estimates of the Incidence and Mortality for 38 Cancers: GLOBOCAN 2018. International Agency for Research on Cancer/World Health Organization, Lyon 2018: gco.iarc.fr.
- Ordinance of the President of the National Health Fund No. 38/2006 from 20th July 2006. . http://www.nfz.gov.pl/zarzadzenia-prezesa/zarzadzenia-prezesa-nfz/zarzadzenie-nr382006,2134.html?fbclid=IwAR0lTW55UlOQvxtcF2p7a5Zeyd3znkrGIF9SmuwWKLIsErhQ0nUHI2zN3wg (08.01.2019).
- Polish Ministry of Health. Prevention of cervical cancer. 26 Jan 2018. https://www.gov.pl/web/zdrowie/profilaktyka-raka-szyjki-macicy (08.01.2019).
- Announcement of the Chief Sanitary Inspector from 25th October 2018 on the National Vaccination Program for 2019. https://gis.gov.pl/wp-content/uploads/2018/01/akt.pdf (08.01.2019).
- European Centre for Disease Prevention and Control: Human Papillomavirus Infection: Recommended vaccinations. https://vaccine-schedule.ecdc.europa.eu/Scheduler/ByDisease?SelectedDiseaseId=38&SelectedCountryIdByDisease=-1 (08.01.2019).
- Ordinance of the Minister of Health from 16th August 2018 on the standard of perinatal care organization. Journal of Laws 2018 item 1756. http://g.ekspert.infor.pl/p/_dane/akty_pdf/DZU/2018/176/1756.pdf (08.01.2019).
- Supreme Audit Office of Poland. Realizacja programów wczesnego wykrywania raka piersi oraz raka szyjki macicy w województwie lubelskim [Implementation of programs for early detection of breast cancer and cervical cancer in the Lubelskie Voivodeship] Warsaw, Supreme Audit Office of Poland, 2017. https://www.nik.gov.pl/plik/id,13641,vp,16077.pdf.
- Ordinance of the Minister of Health from 20th September 2012 on standards of perinatal care. Journal of Laws 2012 item 1100. http://prawo.sejm.gov.pl/isap.nsf/download.xsp/WDU20120001100/O/D20121100.pdf (08.01.2019).
- Stonehocker J. Cervical cancer screening in pregnancy. Obstet Gynecol Clin North Am. 2013; 40(2): 269–282.
- World Health Organization. Comprehensive cervical cancer control: a guide to essential practice, 2nd ed. Geneva, World Health Organization, 2014. https://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/.
- Morimura Y, Fujimori K, Soeda S, et al. Cervical cytology during pregnancy--comparison with non-pregnant women and management of pregnant women with abnormal cytology. Fukushima J Med Sci. 2002; 48(1): 27–37.
- Tenti P, Zappatore R, Migliora P, et al. Latent human papillomavirus infection in pregnant women at term: a case-control study. J Infect Dis. 1997; 176(1): 277–280.
- McIntyre-Seltman K, Lesnock JL. Cervical cancer screening in pregnancy. Obstet Gynecol Clin North Am. 2008; 35(4): 645–658; x.
- Chan PKS, Chang AR, Tam WH, et al. Prevalence and genotype distribution of cervical human papillomavirus infection: Comparison between pregnant women and non-pregnant controls. J Med Virol. 2002; 67(4): 583–588.
- Grce M, Husnjak K, Matovina M, et al. Human papillomavirus, cytomegalovirus, and adeno-associated virus infections in pregnant and nonpregnant women with cervical intraepithelial neoplasia. J Clin Microbiol. 2004; 42(3): 1341–1344.
- Gonçalves CV, Duarte G, Costa JS, et al. Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J. 2009; 127(6): 359–365.
- McDonald S, Faught W, Gruslin A. Cervical Cancer During Pregnancy. Journal of Obstetrics and Gynaecology Canada. 2002; 24(6): 491–498.
- Khaengkhor P, Mairaing K, Suwannarurk K, et al. Prevalence of abnormal cervical cytology by liquid based cytology in the antenatal care clinic, Thammasat University Hospital. J Med Assoc Thai. 2011; 94(2): 152–158.
- Yamazaki T, Inaba F, Takeda N, et al. A study of abnormal cervical cytology in pregnant women. Arch Gynecol Obstet. 2006; 273(5): 274–277.
- Nygård M, Daltveit AK, Thoresen SO, et al. Effect of an antepartum Pap smear on the coverage of a cervical cancer screening programme: a population-based prospective study. BMC Health Serv Res. 2007; 7: 10.
- Nygård JF, Nygård M, Skare GB, et al. Pap smear screening in women under 30 in the Norwegian Coordinated Cervical Cancer Screening Program, with a comparison of immediate biopsy vs Pap smear triage of moderate dysplasia. Acta Cytol. 2006; 50(3): 295–302.
- Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012; 16(3): 175–204.
- Brun-Micaleff E, Coffy A, Rey V, et al. Cervical cancer screening by cytology and human papillomavirus testing during pregnancy in French women with poor adhesion to regular cervical screening. J Med Virol. 2014; 86(3): 536–545.
- Dickinson JA, Ogilvie G, Van Niekerk D, et al. Evidence that supports policies to delay cervical screening until after age 25 years. CMAJ. 2017; 189(10): E380–E381.
- Ulman-Włodarz I, Nowosielski K, Romanik M, et al. Awareness of cervical cancer prevention among patients of gynecological outpatient clinic. Ginekol Pol. 2011; 82: 22–25.
- Monteiro PB, Monteiro Filho MP, de Figueirêdo JT, et al. Cytology-Based Screening During Antenatal Care as a Method for Preventing Cervical Cancer. Asian Pac J Cancer Prev. 2017; 18(9): 2513–2518.
- Eaker S, Adami HO, Sparén P. Attitudes to screening for cervical cancer: a population-based study in Sweden. Cancer Causes and Control. 2001; 12(6): 519–528.
- Augusto EF, Rosa MLG, Cavalcanti SMB, et al. Barriers to cervical cancer screening in women attending the Family Medical Program in Niterói, Rio de Janeiro. Arch Gynecol Obstet. 2013; 287(1): 53–58.
- Spaczyński M, Nowak-Markwitz E, Januszek-Michalecka L, et al. Women’s social conditions and their participation in Cervical Cancer Population Screening Program in Poland. Ginekol Pol. 2009; 80: 833–838.
