PATTERN AND FACTORS AFFECTING PAP SMEAR 
TEST IN NABLUS, A RETROSPECTIVE STUDY

Key words: Pap smear, cervical cytology, Palestine

Abstract:
Background: This retrospective study was performed at the Family Practice clinic, Nablus, in the West Bank/Palestine. The objective of the study was to determine pattern and factors influencing pap smear test, and involved 201 women visiting the clinic for different gynecologic problems during the year 2002. 

Methods: We analyzed the records of all patients who had pap smear done during this period, categorizing their age, occupation, level of education, their obstetric history including number of deliveries, methods of contraception, and menstrual period regularity.

Results: About 12% of the study sample had abnormal (precursors of cervical cancer) results and the majority (88%) had normal and benign changes. There was no statistically significant relationship between the cervical cytology pap results and age, occupation, education, smoking, parity, contraceptive method or frequency of genital infections. 

Conclusion: More than 50% of women in the study heard about pap test through their doctor. Primary health care doctors and gynecologists are encouraged to offer pap tests for their patients. A screening program for cervical cancer is called for through collaboration between all Palestinian health providers.

Introduction
Pap smear is a relatively simple cost-effective screening test that is carried out in conjunction with gynecologic exam at the primary health care level to detect abnormalities that might lead to cervical cancer (1). Pap test is at present the most essential element in prevention of developing cervical cancer (2).

Globally, cancer of the cervix is the second most common cancer in women after breast cancer, and is the most common cancer of women in developing countries, where it is estimated that only about 5% of women have been screened for the disease with pap smear, compared to 40-50% in developed countries (3). In Palestine, limited information is available on the incidence of cervical cancer in the West Bank and Gaza strip, and the mortality resulting from it. One review shows that the incidence of cervical cancer for 1991-1992 in the West Bank and Gaza was 2.3/100,000 females (4).

In review of literature, there are very few studies done on pap smear or cervical cancer in the Arab countries. Altaf found that 3.1% of screened cytology cases in Western Saudi Arabia have abnormal cervical smears (5).

A pap smear study in the west Bank, Palestine found that most of pap smears were done by Non Governmental Organizations or charitable institutions (81%), and only 18% were done by private clinics. The study also found that only 12 % of pap smears were done in Nablus area (6).

The aim of this study is to determine the pattern of cervical cytology of pap smears in Nablus area. The study also aims to find if there is any association between cytology results and risk factors for cervical cancer.