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 Table of Contents  
BRIEF COMMUNICATION
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 29

Cervical cancer screening in patients with total hysterectomy in a diagnostic center at Mexico City


Department of Surgical Oncology, Hospital General Tacuba, ISSSTE, Mexico City, Mexico

Date of Submission01-Mar-2020
Date of Acceptance10-Jun-2020
Date of Web Publication23-Feb-2022

Correspondence Address:
Carlos Manuel Ortiz-Mendoza
Department of Surgical Oncology, Hospital General Tacuba, ISSSTE, Mexico City
Mexico
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpvm.IJPVM_101_20

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  Abstract 


Background: The aim of this study was to outline the Pap smears rate done in women with total hysterectomy, sent to an urban diagnostic center that attends Mexican Government workers in the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE: State´s Employees´ Social Security and Social Services Institute) at Mexico City. Methods: It was a retrospective study on Pap smear reports taken in 2017. The reports came from users of four family medicine clinics and a general hospital´s gynecology service. Demographic facts, instruments for collection, kind of insurance (ISSSTE-insurance or non-insurance), and total hysterectomy history were evaluated. Results: From 4989 reports, 600 (12%) had a total hysterectomy history. In the patients with ISSSTE-insurance, 586 of 4618 (12.68%) had a Pap smear whereas in the patients with non-insurance, only 14 of 371 (3.7%) had it, and this difference was significant (P < 0.00001; OR 3.7, 95% IC 2.15-6.36). Conclusions: Although Pap smear is not indicated in women with total hysterectomy, this study is still carried out frequently.

Keywords: Cancer, cervical cancer, hysterectomy, pap smear, screening


How to cite this article:
Ortiz-Mendoza CM. Cervical cancer screening in patients with total hysterectomy in a diagnostic center at Mexico City. Int J Prev Med 2022;13:29

How to cite this URL:
Ortiz-Mendoza CM. Cervical cancer screening in patients with total hysterectomy in a diagnostic center at Mexico City. Int J Prev Med [serial online] 2022 [cited 2022 May 25];13:29. Available from: https://www.ijpvmjournal.net/text.asp?2022/13/1/29/338078




  Introduction Top


Cervical cancer is still a major cause of morbidity and mortality in Mexico.[1] Because it is a disease with identifiable pre-invasive lesions,[2],[3] its timely detection through diverse screening studies is feasible.[2],[3] The use of these different screening methods depends on the organization of the local health system and the resources available.[2],[3] Because the material resources to identify cervical preinvasive lesions can consume large amounts of the institutional budget,[4],[5] it is essential to make screening more effective and efficient.

In Mexico, there are specific Government guidelines for cervical cancer screening.[6] However, our empirical impression is that these guidelines are not followed truly; and, there are patients with total hysterectomy who undergo regular Pap smears screening. Because there are no studies on this regard, we decided to outline the Pap smears rate done in women with total hysterectomy.


  Materials and Methods Top


The department of Pathology at the “Hospital General Tacuba” is a diagnostic reference center for Pap smears taken in the units of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE: State´s Employees´ Social Security and Social Services Institute; medical facilities of the Mexican government to their workers) in the Western part of Mexico City. The Pap reports analyzed were those safeguarded in the department of Pathology. It was a descriptive research, with a case-control analysis, on the Pap reports taken during 2017 in four family medicine clinics and in a general hospital gynecology service. The study´s protocol was approved by the institutional research and ethics committees (# 659.2018).

Population

The Pap smears were taken opportunistically from the insured (ISSSTE workers, pensioners, or beneficiaries) and in non-insured patients (because this is a priority service in Mexico). In the units where cervical cytology was done, identity and demographic data were recorded. In addition, reproductive history, collection instrument used, study regularity, and total hysterectomy history were documented. The cytology and their report were received in the pathology service, registered, processed, and diagnosed. Those reports with a history of supra-cervical hysterectomy, illegible, and incomplete data were excluded.

Analysis

With the information reached, we assessed Pap smears rate done in women with total hysterectomy, and whether the Pap smears regularity was related to their medical insurance (ISSSTE-insurance or non-insurance). Data were analyzed with the Pearson's χ2; the statistic program OpenEpi version 3 (Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, USA, www.openepi.com) was used. All P values <0.05 were considered statistically significant.


  Results Top


Of 5,617 Pap smear reports evaluated, we obtained complete information from 4,989 reports. From these 4,989 reports, there were 600 cases with a history of total hysterectomy (12%). Active workers were the most frequent group in which the Pap smear was taken (n = 391, 65.1%), aged between 50 and 59 years (n = 259, 43.1%) [Table 1].
Table 1: Features of patients with hysterectomy (n=600)

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The instrument most frequently used was the Cervex-Brush® (n = 374, 62.3%), and the study was done most often with a regularity of ≤1 year (n = 238, 39.6%); [Table 1]. In the ISSSTE-insurance patients, the Pap smear history was more frequent (586 of 4,618 = 12.68%) than in the non-insurance patients (14 of 371 = 3.7%), with significance: P <0.00001; OR 3.7, 95% CI 2.15–6.36.


  Discussion Top


Our study recognized that women with hysterectomy underwent the Pap smear frequently. However, this situation is not exclusive to Mexico; thus, in Korea and USA it was found that screening for cervical cancer is also frequent in women without a uterine cervix.[7],[8]

We notice in the sample assessed, the instruments most used to collect the Pap smear are those designed for the cervix anfractuous characteristics. It is important to remember that material resources used to identify cervical pre-invasive lesions can consume huge amounts of the institutional budget.[4],[5]

Similar to other studies this one has limitations. It was a retrospective study in an urban area and there is no information about personal cervical cancer history. However, our research is valued since it assessed a large number of patients. And finally, there are no previous similar studies in Mexican women with total hysterectomy.

Concluding, although Pap smear is not indicated in women with total hysterectomy, this study is still carried out frequently.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aldaco-Sarvide F, Pérez-Pérez P, Cervantes-Sánchez G, Torrecillas-Torres L, Erazo-Valle-Solís AA, Cabrera-Galeana P, et al. Mortality from cancer in Mexico: 2015 update. GAMO 2018;17:28-34.  Back to cited text no. 1
    
2.
Schiffman M, Wentzensen N. High-Quality Risk-based Cervical Cancer Screening for the U.S. and the World: A Realistic example of precision prevention. Available from: https://deainfo.nci.nih.gov/advisory/joint/1117/04-SchiffmanWentzensen.pdf. [Last accessed on 2019 Nov 12].  Back to cited text no. 2
    
3.
World Health Organization. Reproductive Health, World Health Organization. Chronic Diseases, & Health Promotion. 2nd ed. Comprehensive cervical cancer control: A guide to essential practice. 2014. Available from: https://apps.who.int/iris/bitstream/handle/10665/144785/9789241548953_eng.pdf; jsessionid=26BDB584D4DFAC592AAF0DA660A5F489?sequence=1. [Last accessed on 2019 Nov 12].  Back to cited text no. 3
    
4.
Granados-García V, Flores YN, Pérez R, Rudolph SE, Lazcano-Ponce E, Salmerón J. Cost of the cervical cancer screening program at the Mexican social security institute. Salud Publica Mex 2014;56:502-10.  Back to cited text no. 4
    
5.
Fetters MD, Lieberman RW, Abrahamse PH, Sanghvi RV, Sonnad SS. Cost-effectiveness of Pap smear screening for vaginal cancer after total hysterectomy for benign disease. J Low Genit Tract Dis 2003;7:194-202.  Back to cited text no. 5
    
6.
Timely prevention and detection of cervical cancer in the first level of care. México [Prevención y detección oportuna del cáncer cérvico uterino en el primer nivel de atención. México]: Instituto Mexicano del Seguro Social. 2010. Available from: http://www.imss.gob.mx/profesionales/guiasclinicas/Pages/guias.aspx. [Last accessed on 2019 Nov 12].  Back to cited text no. 6
    
7.
Shin JY, Choi KS, Suh M, Park B, Jun JK. Comparison of cervical cancer screening among women with and without hysterectomies: A nationwide population-based study in Korea. BMC Cancer 2018 11;18:810.  Back to cited text no. 7
    
8.
Teoh D, Isaksson Vogel R, Hultman G, Monu M, Downs L, Geller MA, et al. Single health system adherence to 2012 cervical cancer screening guidelines at extremes of age and posthysterectomy. Obstet Gynecol 2017;129:448-56.  Back to cited text no. 8
    



 
 
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