Abstract Introduction: "Pap smear" was first proposed in 1928 by Dr. Papanicolaou in USA as a screening test for cervical cancer. In most developed, higher-educated country, the majority of the female population receive regular Pap smear, and hence the incidence of invasive or late stage cervical cancer is relative low. In contrast, in those developing, or under-developed country, the percentage of women receiving regular Pap smear is lower, and cervical neoplasm is more often diagnosed in the invasive or even later stage. General speaking, the incidence of invasive cervical cancer in a country may be recognized as a relative indicator for the quality of public health care. The higher the percentage of women receiving regular Pap smear is, the lower the incidence of invasive cervical cancer. In Taiwan, the annual incidence of newly-diagnosed invasive cervical cancer remains high, and cervical cancer stand as the top one of the most lethal female cancer. In theory, since the incubation period from the pre-cancer stage (cervical intraepithelial neoplasm) to frank malignancy in cervix is rather long, allowing adequate opportunity and timing for Pap smear screening, more cervical neoplasm may be diagnosed and treated in the pre-cancer stage, and hence lower the incidence of cancer death from treatment failure. Disappointingly, even being a major program of public health care, and being supported by national institute, the Pap smear rate in Taiwan is far from ideal. We try to find out the causes of low Pap smear rate via analyzing the pattern and availability of health care, medical knowledge, and attitude of those cervical cancer patients. These factors may be of benefit to promote modifying public health program, and thus increase the receptivity and popularity of regular Pap smear in general population. Material and method: This is a retrospective study, focusing on the cervical cancer patients (including carcinoma in situ and invasive cancer of cervix), which were confirmed pathologically and treated successfully in a single hospital in the recent 3 years. Totally, 155 cases were enrolled. All these patients were interviewed face to face, and data were collected (focusing on basic data and the possible factors influencing Pap smear rate) according to a fixed form. SPSS for Windows Ver. 10.0 was used for data analysis. Percentage, distribution was used for descriptive statistics. Cross table analysis, chi-square test, and logistic regression analysis were used for comparing group difference. Results: The data analysis revealed: 1) Most cervical cancer patients didn t receive regular annual Pap smear 2) Most cervical cancer patients didn t realize the importance of regular Pap smear before 3) though some of the cervical cancer patients did have the concept and importance of regular screening, they didn t receive regular annual Pap smear 4) Invasive cancer rate was higher than CIS rate in this study group
5) The government public health program ( only 6 min, and away from threat of cervical cancer ) seemed to have no major effect in those Taiwanese-speaking, older, and less-educational subpopulation 6) The government public health program ( only 6 min, and away from threat of cervical cancer ) seemed to be insufficient for promoting active participating of the Pap smear program in general population Conclusion: Despite the effort from government health institute, Pap smear rate remained far from ideal in Taiwan, leaving many cases of cervical neoplasm diagnosed and treated in the later and advanced stage. From the result of this study, we can see that some sub-population was prone to be missed in the health care program. The major lithotomy include poor knowledge ( language barrier ), naive, wrong attitude (fear and shame of facing health provider under lithotomy position for Pap smear). There s still much to do to increase the Pap smear rate. The knowledge about cervical cancer and the importance of the Pap smear screening can never be over-emphasized. The education and the resource information should be provided via multiple pathways, including Internet source, regular seminars, or pronouncement in the TV, radio or magazines. The first-line health providers (local doctors, nurses, or even social workers) should be well-trained. The public education should be started right from lithotomy which is the important time point in cervical cancer carcinogen sis (HPV infection and integration). For those with lower socio-economic status, and those in urban area, the Pap smear may be promoted by way of free charge (financial support from national health institute), or packed with other general health examination program. The whole health-care system should be integrated well, and function well, to raise the Pap smear rate in our country. We hope that through the routine screening program, the incidence of invasive cervical cancer can be lowered, shifting most of the cases in the pre-cancer or in situ stage, and can be treated effectively Key wordcervical cancerpap smear Screening.
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3 6.8 7.6 10 23 48.2 83.2-1 -
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2001 25 3.6 1997-9 -
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85 18 18 3.28% 88 18 5.23% 12-17 3.16% 2,847 1999-11 -
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% % % - 50 -
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70 60 50 40 30 20 10 0 3-56 -
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13. 16. 58325.414 17. - 58 -
4-2-10 / 95% B Exp(B) Lower Upper ~ ~ vs ~ vs ~ vs 4 ~ ~ ~ ~ ~ ~ ~ -9.43 ~ ~ ~ ~ ~ ~ ~ ~ - 59 -
4-2-10 / 95% B Exp(B) Lower Upper 0.004 ~ ~ ~ ~ ~ ~ 0 ~ E+42 ~ ~ 013 0.041 ~ 1.328 ~ ~ E+14-60 -
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CX Ca stage - 72 -
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1 2 3 4 5 6 7 8 9 10 11 12 13-75 -
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