Statistical survey of PAP smears in a Lebanese population

1. Survey of Cervical Screening
in the South of Lebanon
Hammoud Hospital University Medical Center
19/12/15
MAZEN FAKIH MD
MONA KHADRA MD FRCOG

2. Statistical Survey of Cervical Cancer
 About 113 new cervical cancer cases are diagnosed
annually in Lebanon (estimates for 2012).
 Cervical cancer ranks as the 11th cause of female cancer in
Lebanon.
 Cervical cancer is the 6th most common female cancer in
women aged 15 to 44 years in Lebanon.
ICO Information Centre on HPV and Cancer,
Human Papillomavirus and Related Diseases Report, 2014.
www.hpvcentre.net

3. Incidence of cervical cancer in Lebanon across the Western
Asia (last update 14 Jul 2014)

4. Cervical cancer is a
preventable disease that
can be screened for and
treated in a timely fashion.

5. Age and frequency of routine screening
 Cervical screening program begins at the age of 25. (Sexually
active women)
 Every 3 years until the age of 49
 Every 5 years until the age of 64
 65+ only screen those who have not been screened since age 50 or
who have had a recent abnormal sample
 Primary HPV testing > 30 every 3-5 years (in the USA).

6. High-risk HPV types that
cause cervical cancer
HPV type
Percentage of cervical cancer
cases caused by HPV type
Cumulative
percentage
16 58.1% 58.1%
18 15.7% 73.8%
33 4.4% 78.2%
31 4.0% 82.2%
45 2.9% 85.1%
35 1.6% 86.7%
58 1.2% 87.9%
56 1.0% 88.9%
52 0.6% 89.5%
39 0.2% 89.7%
51 0.2% 89.9%
68 0.3% 90.2%
59 0.1% 90.3%
Other 1.4% 91.7%
No type identified 8.3% 100%
Adapted from Smith JS et al.,
2007; Int J Cancer.
121(3):621-32.
Percentage of cervical cancer cases caused by oncogenic
HPV types in Europe

7. Percentage of different
cancers caused by HPV
7
Percentage of different cancer types caused
by high-risk HPV types
Cancer site Percentage of
cases caused by
HPV
Cervix > 99%
Penis 40%
Vulva, vagina 40%
Anus 90%
Mouth 3%
Oropharynx 12%
Source: Prof Margaret Stanley, University of Cambridge

8. Our Survey
 Survey of awareness and frequency
of cervical smears in 500 women.
 The survey covers the areas
surrounding Sidon and Tyre.
 Statistical analysis was performed
using IBM SPSS ver. 14.
 Eight questions were asked:
 Age
 Marital status
 Number of Children
 Have you ever had a smear? (Y,N)
 Age at first smear
 When was the last smear?
 How often do you have a smear?
 Any abnormal results?
 Occupation

9. Age Distribution (n=500) by age group
10
66
381
43
Age
Less than 20 21-25 26-50 More than 50
Range of ages: 17-73 y
Average (mean) age: 35.54 y
Most reported age (Mode): 27 y

10. Number of Children vs Number of
Women (n=500); Range 0-12
100 104
115
83
48
25 17 8
0
20
40
60
80
100
120
140
0 1 2 3 4 5 6 7 or more
Number of Children
Series 1

11. Have You Ever Had A Smear?
217, 43%
283, 57%
Number of Enrolled Women (500)
Yes No

12. If no, then why? (Reasons) n=283
126
41
22 18
44
0
20
40
60
80
100
120
140
Not informed
by doctor
Neglect No need for it Does not
know what it
is
Other reasons
Reason
Reason
Considering it 3
Doctor said no need 1
Embarrassed 1
Newly wed 5
No family history of CA 2
No symptoms 3
No time 1
Not active enough 3
Scared 1
Scarring 8
Too young 4

13. No PAP Smear Status Distribution by Age
(n=283)
9 56
207
11
0
50
100
150
200
250
Less than 20 21-25 26-50 More than 50
Distribution by Age of women who did not have a PAP smear
No PAP

14. No PAP Smear Status Distribution by
Number of Children (n=283); Range 0-
12
89
73 69
18 15 9 4 6
0
20
40
60
80
100
0 1 2 3 4 5 6 7 or more
Number of Children of those who did not have a PAP smear
Series 1

15. Occupation of Women Who DID Not
Have a PAP Smear (n=283)
166
42
7 7 4
57
0
20
40
60
80
100
120
140
160
180
Unemployed Teacher Lab technitian Nurse Secretary Others
Series 1

16. Distribution by Age of Women Who Had a
PAP Smear (n=217)
0 10
175
32
0
50
100
150
200
Less than 20 21-25 26-50 More than 50
Distribution by Age of women who did have a PAP smear
PAP

17. Distribution by Number of Children of
Women Who Had a PAP Smear(n=217);
Range 0-7
11
31
46
66
33
16 13
1
0
10
20
30
40
50
60
70
0 1 2 3 4 5 6 7 or more
Number of Children of those who did have a PAP smear

18. Occupation of Women Who Had a PAP
Smear (n=217)
131
26
0
11
2
47
0
20
40
60
80
100
120
140
Unemployed Teacher Lab technitian Nurse Secretary Others
Series 2

19. Age at First Smear
Minimum
Age
Maximum
Age
Average
Age
18 64 31.7
Pearson = 0.564 p=0.001

20. Distribution by Age of Women
Who Had Only One PAP Smear n=107
0 9
83
150
20
40
60
80
100
Less than 20 21-25 26-50 More than 50
Distribution by Age of women who did have only one PAP smear
Only One PAP

21.  Mean frequency of repeating the smear is 10 months. (½-15 years) Most
of them had it at one year (mode).
10
36
0 5 10 15 20 25 30 35 40
PAP Smear Repetition
Recommended Frequency Observed frequency
How Often Do Women Do a PAP Smear?
(months = 3 years)
months

22. How Often Do Women Do a PAP Smear?

23. Have You Ever Had An Abnormal
Smear Result?
11; 5%
206; 95%
Women
Abnormal

24. Independent Samples Test
 Correlation between:
Age and PAP smear:
F=6.1 p=0.014 CI 95% [-9.5,-6.2]
Occupation and PAP smear:
F=4.1 p=0.042 CI 95% [-3.14,1.32]

25. Conclusions
 57% of surveyed eligible women never had a smear.
 There is no correlation between a woman’s occupation and
doing the PAP smear.
F=4.1 p=0.042 CI 95% [-3.14,1.32]
 There is a correlation between a woman’s age and doing
the PAP smear: the older the woman, the less likely to do a
smear.
F=6.1 p=0.014 CI 95% [-9.5,-6.2]

26. Recommendations and Plan
 Awareness campaign for women and doctors:
Presentations in community centers
Posters
Minister of heath information leaflets
Bundling leaflets with women’s sanitary products