Introduction:
It is commonly accepted that HPV is the precursor to
cervical cancer. Effective screening programs have
decreased the incidence of cervical cancer in women in
developed countries, but worldwide cervical cancer is
the second most common cause of death. Less information
is known about the prevalence of HPV and dysplasia in
third world countries. The aim of this study was to find
the prevalence of HPV and cervical dysplasia in a rural
town of Nigeria.
Design:
In March of 2004, a medical mission project was
performed in Okene, Kogi State, Nigeria through the
Christian Medical Fellowship (www.C-M-F.org). During the
course of the mission, the ObGyn team evaluated 231
consecutive patients. Thin PrepTM PAP smears were
collected by the standard technique on two hundred
patients (age ranging from 19 to 65 years; average age
33 years) who met our criteria of not being pregnant and
not having a known history of cervical dysplasia or
cervical cancer. One hundred and ninety nine PAP smears
were available for cytologic analysis and HPV DNA
detection (performed using Digene HPV DNA Hybrid Capture
IITM test.
Results:
Of the patients seen, 3 (1.4%) claimed to have had a PAP
smear in the past. Fifteen patients (6.7%) had never
seen a doctor before and 161 (72%) had seen a doctor
four or less times in their life. Of the 199 PAP smears
performed, 22.6% had either High Risk (HR) HPV, Low risk
(LR) HPV, or both. HR HPV was present in 18.1% of the
women. There were 13 (6.5%) abnormal PAP smears, and of
those there were 9 (4.5%) cases of ASCUS, 1 (0.5%) AGUS,
2 (1%) LSIL, 1 (0.5%) HSIL and (0.5 %) AGUS. Other
findings were Trichmonas vaginalis in 18 cases (9%) and
Candida in 27 (13.5%).
Conclusion:
The incidence of HPV and abnormal pap smears was higher
in our population than in the United States as reported
by the Centers for Disease Control. The incidence of HPV
and abnormal PAP smears, however, was lower in our study
population than previous studies conducted in other
African cities. Improved access to health care and
implementation of cervical cancer screening programs may
help decrease the transmission of HPV and subsequent
cervical cancer in underprivileged areas.
Markelova N, Schnatz PF, Holmes D, Harp J, Stevens K, et
al.
Modern Pathology 2005; 18 (1): 72A.
