Iranian Society of Gynecology Oncology


1 Department of Obstetrics and Gynecology, Infertility fellowship, Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.

2 Department of Obstetrics and Gynecology, Oncology fellowship, Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.

3 Department of Obstetrics and Gynecology, Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.

4 General Practitioner, Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.

5 Medical student, Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.


Background & Objective: The importance of Pap smear in cervical cancer screening is clear. However, yet no organized program has been developed in Iran to screen cervical cancer. Due to the obvious difference in prevalence of cervical cancer in Iran compared to global statistics, it is necessary to further investigate this issue. As pop smear is the most important factor to decrease the mortality and morbidity of cervical cancer in developed countries, it is important to study the results of abnormal Pap smears and the quality of the report in our region.
 Materials & Methods: This study was designed retrospectively with reference to the results of Pap smears performed during 3 years from 2016 in the Kosar hospital. The method of collecting samples was census. The results of Pap smears were extracted from the Hospital and 15208 pap smear results were analyzed.
Results: From the 15208 women, 15150 had normal cytology results (99.62%) and 58 women had abnormal cytology (0.38%). The frequency of abnormal cytology was 0.246% (n=37) for atypical squamous cell of undetermined significance (ASCUS), 0.08% (n=12) for low-grade squamous intraepithelial lesion (LSIL), 0.006% (n=1)for ASC cannot exclude high-grade intraepithelial lesion (ASC-H), 0.046% (n=7) for high-grade squamous intraepithelial lesion(HSIL), 0.006 (n=1)for atypical glandular cells (AGC), and 0% (n=0) for invasive cancer. No SCC was found in this study. Conclusion: The prevalence of all abnormal results was much lower than other studies; However, in terms of prevalence of abnormalities, the ranking was similar to other studies.In order to obtain more accurate results, it is recommended to study other epidemiological regions.


  1. [1] Freddie Bray, BSc, MSc, PhD1, ME2 Jacques Ferlay, and MD, MSc, PhD3 Isabelle Soerjomataram. "Global Cancer Statistics 2018: GLOBOCAN Estimates." CA CANCER J CLIN, 2018: 1–31 [2] Gholamreza Roshandela, b, Ali Ghanbari-Motlaghc, Elham Partovipourb, Fereshteh Salavatib,. "Cancer incidence in Iran in 2014: Results of the Iranian National Populationbased." Cancer Epidemiology 61 , 2019: 50-58 [3] Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999; 318:904 [4] Willoughby BJ, Faulkner K, Stamp EC, Whitaker CJ. A descriptive study of the decline in cervical screening coverage rates in the North East and Yorkshire and the Humber regions of the UK from 1995 to 2005. J Public Health (Oxf) 2006; 28:355 [5] Saraiya M, Ahmed F, Krishnan S, Richards TB, Unger ER, Lawson HW. Cervical cancer incidence in a prevaccine era in the United States, 1998-2002.Obstet Gynecol. 2007;109(2 Pt 1):360-370 [6] Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189:12 [7] Nobbenhuis MA, Walboomers JM, Helmerhorst TJ, et al. Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: a prospective study. Lancet 1999; 354:20 [8] Kjaer SK, van den Brule AJ, Paull G, et al. Type specific persistence of high risk human papillomavirus (HPV) as indicator of high grade cervical squamous intraepithelial lesions in young women: population based prospective follow up study. BMJ 2002; 325:572 [9] Wallin KL, Wiklund F, Angström T, et al. Type-specific persistence of human papillomavirus DNA before the development of invasive cervical cancer. N Engl J Med 1999; 341:1633 [10] Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 168: Cervical Cancer Screening and Prevention. Obstet Gynecol 2016; 128:e111. Reaffirmed 2018 [11] Dobbs SP, Asmussen T, Nunns D, Hollingworth J, Brown LJ, Ireland D. Does histological incomplete excision of cervical intraepithelial neoplasia following large loop excision of transformation zone increase recurrence rates? A six year cytological follow up. BJOG. 2000;107(10):1298-301 [12] Martin-Hirsch P, Jarvis G, Kitchener H, Lilford R. Collection devices for obtaining cervical cytology samples. Cochrane Database Syst Rev 2000; :CD001036 [13] Katki HA, Schiffman M, Castle PE, et al. Benchmarking CIN 3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and management guidelines. J Low Genit Tract Dis 2013; 17:S28 [14] Paolo Giorgi Rossi, Alessandro Ricciardi, Catherine Cohet,. “Epidemiology and costs of cervical cancer screening and cervical.” BMC Public Health,, 2009: 9:71 [15] Seung-Hyuk Shim, Hyeongsu Kim , In-Sook Sohn , Han-Sung Hwang,. "Nationwide cervical cancer screening in Korea: data from the National Health Insurance Service Cancer Screening Program and National Cancer Screening Program, 2009–2014." J Gynecol Oncol, 2017 Sep;: 28(5):e63 [16] Bayan Maraqa, Isam Lataifeh, Lian Otay, Osama Badran, Yasar Qutaiba. “Prevalence of Abnormal Pap Smears: A Descriptive Study from.” Asian Pacific Journal of Cancer Prevention, Vol 18, 2017: 3117-3121 [17] Addis I, Kenneth D, Berek J. Intraepithelial disease of the cervix, vagina and vulva. In: Berek J, editor. Novak’s Gynecology. 16th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 561-85 [18] İlknur Çeti naslan TÜRKMEN1, Alp USUBÜTÜN2, Aslı ÇAKIR1, Özlem AydIn3, Filiz Aka Bolat 4,. "What does the Data of 354,725 Patients from Turkey Tell." (Turk Patoloji Derg 2017, 33:134-143), 2017: 134-143 [19] Akbari, F Almassi Nokiani.H. "Prevalence of invasive and pre- invasive cervical lesions in Kermanshah." JQUMS, Vol.13, No.1, Spring 2009, 2009: 42-48 [20] Maleki A, Ahmadnia E, Avazeh A, Mazloomzadeh S, Molaei B, Jalilvand A. Prevalence of abnormal papanicolaou test results and related factors among women living in Zanjan, Iran. Asian pacific journal of cancer prevention. Vol 16. 2015 [21] Asnafi N, Shafaei SH, Abdalmaleki SH. "Investigation of abnormal histology and cytology of cervix." jornal of babol university of medical science, 2004: 21-25. [22] Clement A, Kayode A, Omoladon O, Omoniyi G.O, Onwundiegu U.Age and pattern of pap smears abnormalities : Implications for cervical cancer control in a developing country. JCYTOL, 2017 Oct-Dec; 34(4): 208-211 [23] urmila banik, et all. "pattern of epithelial cell abnormality in pap smear." cytojournal, 2011: 25-30 [24] masoumi sz, et all. "the prevalence of abnormal pap smears in females referred to health centers." journal of education and community health, 2016.16-22 [25] Allame T, et all. "the prevalence of abnormal pap smear results in women attending to esfahan clinics." journal of esfahan medicine college, 2012: 28-31 [26] Arab badkoube kh, et all. "the relevance ofthe results of the pap smear test to the pathology results." journal of nursing and midwifery, 2018: 8-15 [27] Diogo Do Nascimento Franco1, Adriana Cunha Vargas Tomáz1, Angela Andréia. "Screening Cervical Cancer by the Pap Test – Relevance of." Screening Cervical Cancer and Age Ranges, APJCP.2017.18.9.2431: 2431-2435 [28] Ioana pavaleanu et all. Preliminary result of the first cervical cancer screening programme in the north eastern reagion of romania. Journal of medical screening. 2018 [29] pankaj s, et all. "comparison of conventional pap smear and liquid based cytology." indian j cancer, 2018: 50-56 [30] Ann T. Moriarty, MD, MD Amy C. Clayton, SCT(ASCP) Sue Zaleski, MD Michael R. Henry, and MD Mary R. Schwartz. "Unsatisfactory Reporting Rates." Arch Pathol Lab Med—Vol 133, 2009: 1912-1916 [31] Hodgson W, Kaplan KJ, Rodriguez M, McHale MT, Rose GS, Elkas JC. The impact of converting to liquid-based cervical cytology in a military population. Gynecol Oncol. 2005; 99(2):422-6 [32] yousefi z, et all. "the prevalence of unsatisfactory cervical cytology in liquid base method comparison to conventional method." journal of gorgan university of medical science, 2006: 12-16 [33] Nayar R, Wilbur DC. The Pap Test and Bethesda 2014: "The reports of my demise have been greatly exaggerated. (after a quotation from Mark Twain)". J Low Genit Tract Dis 2015; 19:175 [34] Harkness CB, Theofrastous JP, Ibrahim SN, Galvin SL, Lawrence HC. Papanicolaou and thin-layer cervical cytology with colposcopic biopsy control. A comparison. J Reprod Med. 2003;48(9):681-6 [35] Tuncer ZS, Başaran M, Sezgin Y, Firat P, Mocan Kuzey G.Clinical results of a split sample liquid-based cytology (ThinPrep) study of 4,322 patients in a Turkish institution. Eur J Gynaecol Oncol. 2005;26(6):646-8 [36] Hoda rs, et all. "gynecologic cytology on conventional and liquid based preparations." diagn cytopathol, 2013: 152-155 [37] Basu P, et all. "secondary prevention of cervical cancer." Best pract res clin obstet gynaecol, 2018: 70-75