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Discussion:
In this study only 12% (25/201) of the study sample had abnormal (precursors of cervical cancer) results and the majority 88 %(76/201) had
normal and benign changes.
This study, the first of its kind to be conducted in Nablus area, shows that
women from different ages will accept pap test if they are offered the test, regardless of their level of education, or occupation. It is obvious
from the data in table 4 that doctors can play important role in offering this
test to their patients (more than 50% of women first knew about the test
from their doctor).
Some of the possible risk factors for cervical cancer has been explored in
this study. Although cigarette smoking is commonly associated with risk of
cervical cancer and some authors consider the association to be causal (8), this association was not statistically significant with cervical cytology
results in this study. The percent of smokers in our study was relatively
small to contribute to any association. However in the literature, Nicotine
has been found in the cervical mucus of smokers and might possibly be a factor in the carcinogenicity of HPV (9).
The biological cause of cervical cancer is not known. However it is now believed to be strongly linked to HPV (Human Papilloma Virus) (10).Other associated risk factors for cervical cancer have been explored. Many
studies have associated cervical cancer with sexual activity with numerous
partners, and epidemiologically it behaves as sexually transmitted disease
(11). Sexual activity before age 15 increases the risk of cervical cancer
tenfolds (12).
Our study found no significant relationship between the frequency of genital
infections and abnormal cervical cytology detected by pap smear.The association between high parity and increased risk of cervical cancer has
been demonstrated in several studies in Western countries (13). The Latin
American Cervical Cancer study showed that women with 12 or more live births were at a four-fold excess risk compared with women with one or no
births (13).In our study, however there was no statistically significant
association between parity and abnormal cervical cytology .
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Although some studies have shown that wives of circumcised men are less at
risk of cervical cancer (for example Jewish women in Israel), there is not
sufficient evidence to generalize this hypothesis. In Lebanon, the incidence
is comparable in circumcised Muslims and non-circumcised Christians (9).
Barrier methods of contraception appear to offer a certain degree of
protection against cervical cancer in both diaphragm users (14), and users of
condoms (15). This protective effect is most probably due to the reduction in incidence of
sexually transmitted diseases. Long term use of oral contraceptives (4years
or more) has been shown in several studies to increase the risk of cervical
cancer in some groups of people (12), due to hormonal influence of oral contraceptives on the cervix. However, this still remains controversial, and
the role of oral contraceptives in the development of cervical dysplasia is
unclear, which goes along with our findings that had no significant relationship between contraceptive method and abnormal cervical cytology.
There is some evidence that folic acid deficiency and low beta carotene levels may increase the risk of cervical dysplasia (12). Cancer
prevention trials are currently being carried out to determine if supplements
are effective in prevention, but at present there is no indication that they
decrease the risk of cervical cancer (16). Low socioeconomic status is a
major risk factor for cervical cancer (17).
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