Spectrum of epithelial cell abnormalities of uterine cervix in a cervical cancer screening programme: Implications for resource limited settings Sanjay Gupta a, * , Pushpa Sodhani a , Kaushik Halder a , Krishan Lal Chachra a , Sarita Sardana c , Veena Singh b , Ashok Sehgal c a Division of Cytopathology, Institute of Cytology and Preventive Oncology (ICMR), NOIDA, India b Division of Clinical Research, Institute of Cytology and Preventive Oncology (ICMR), NOIDA, India c Division of Epidemiology, Institute of Cytology and Preventive Oncology (ICMR), NOIDA, India Received 22 December 2005; received in revised form 13 July 2006; accepted 14 July 2006 Abstract Objective: (1) To compute the frequencies and peak age incidences of epithelial cell abnormalities (ECA) of uterine cervix in a cytology- based screening programme and (2) to analyze the comparative frequencies of squamous intraepithelial lesions (SIL) and malignancies in age groups <40 and 40 years, in order to assess the implications for screening protocol in resource limited settings. Study design: Pap smears form 29,475 women were cytologically screened over a 4-year period as a part of hospital-based screening programme. The frequencies, peak age incidences and mean age of various ECA detected were computed. The data was further stratified in to age groups <40 (Gp 1) and 40 (Gp 2) and comparative profile of the lesions was analyzed. Results: On cytologic screening of the smears 5.6% ECA were detected. Atypical squamous cells-undetermined significance (ASC-US) and low grade SILs (LSIL) were diagnosed more frequently in Gp 1 ( p < 0.001) while atypical glandular cells (AGC) and malignancies were more significantly more frequent in Gp 2 ( p < 0.001). The frequency of HSIL was similar in the two groups. The SILs predominated in the fourth decade while the malignant lesions were most frequent in age >50 years. The mean age for LSIL and HSIL was 34.7 and 37.7 years, respectively, while for malignancy it was 51.8 years thus corroborating the hypothesis that a prolonged latent phase exists between the precursor lesions and the onset of invasive cancer. Conclusions: Since the goal of any screening programme should be to pick up majority of the precursor lesions and not frank cancers, it is desirable to initiate screening before 40 years of age. The WHO recommendation of once in a life time screening between 35 and 40 years of age seems appropriate for resource limited settings like ours. # 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Epithelial cell abnormalities (ECA); Cervical cancer; Squamous intraepithelial lesion (SIL); Screening; Atypical squamous cells (ASC) 1. Introduction Cervical cancer is a global health problem. Worldwide, it comprises approximately 12% of all cancers among women. According to the recent data, an estimated 470,600 new cases of cervical cancer occur among women worldwide each year, the vast majority of them in developing countries. Of the 233,000 women who die of cervical cancer annually, approximately 80% are from developing countries where it is the leading cause of cancer deaths among women [1]. The age distribution of invasive cancer of cervix shows a pattern with a rise that starts in early twenties, continues up sharply in thirties and plateaus at 40–50 years of age. On the other hand, the precancerous lesions occur in women <40 years of age. Thus there is a prolonged detectable preclinical phase lasting about a decade and half, which provides ample opportunity for screening and early detection of cervical cancer [2]. If we look at the magnitude in India, cervical cancer comprises the commonest cancer in women. It is estimated www.elsevier.com/locate/ejogrb European Journal of Obstetrics & Gynecology and Reproductive Biology 134 (2007) 238–242 * Corresponding author at: 17 Pocket E, Mayur Vihar Phase II, Delhi 110091, India. Tel.: +91 120 2579471; fax: +91 120 2579473. E-mail address: sanjaydr17@hotmail.com (S. Gupta). 0301-2115/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2006.07.022