Opportunistic testing of medically underserved women for cervical cancer in South Africa

OBJECTIVE: To determine the yield of opportunistic Pap smears taken in an u nscreened and medically underserved population in the Transkei Region of So uth Africa. STUDY DESIGN: Cosssectional study of 22,160 cervical cytology specimens fro m an unscreened population attending gynecologic outpatient clinics between January 1990 and December 1996. RESULTS: The overall prevalence of atypical squamous cells of uncertain sig nificance (ASCUS), low, grade squamous intraepithelial lesions (LSIL) and h igh grade squamous intraepithelial lesions (HSIL) was, respectively, 34.7%, 8.3% and 2.4%. The ASCUS:SIL ratio was 3:1. The prevalence of invasive squ amous carcinoma was 1.6%. The yield of opportunistic Pap smears was 10.7% i ncluding only LSIL and HSIL. CONCLUSION: The pathologic process of precursor lesions of cervical cancer appears to start at an early age since > 20% of cases are diagnosed before the age of 30 ;years. In the absence of a national screening program, oppor tunistic testing of medically underserved women needs to br maintained and encouraged.