Do Health Care Providers Have a Lower Prevalence of Abnormal Pap Smears than the General Public?
Komsun Suwannarurk MD*, Konkarn Bhamarapravatana PhD**, Pakpoom Kheolamai PhD**, Yuttadej Thaweekul MD*, Karicha Mairaing MD*, Yenrudee Poomtavorn MD*, Junya Pattaraarchachai PhD***
Affiliation : * Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. *** Department of Community Medicine , Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : Most Thai people believe that health care providers have a lower risk of any disease than their patients. This
belief may lull Thai health care providers into accepting the false belief that they are at a lower risk of having the precancerous
conditions that lead to cervical cancer.
Objective : This study compares the prevalence of abnormal Pap smears from health care providers (HC) and non health
care providers (NHC) by using the standard liquid-based Pap smear processing at Thammasat University Hospital’s
pathology department, Thailand.
Material and Method: Both health care providers (HC) and non health care providers (NHC) were patients at the outpatient
clinic, Thammasat University Hospital. They were screened for cervical cancer by using liquid-based Pap smear (LBP).
Cytological diagnoses and specimen adequacy were classified using the Bethesda system 2001. All subjects who had abnormal
cytology more than atypical squamous cells or atypical glandular cells were counseled to have performed a colposcopic
directed biopsy for confirmation of pathology.
Study
Results : A total of 250 liquid-base Pap smears were processed and evaluated at the Gynecology clinic, Thammasat
University Hospital from April 2008 to May 2008.
Results : The groups of HC and NHC consisted of 122 and 128 women, respectively. In general, both the HC and NHC groups
were similar in their age, religion, income and education level distributions. The range of ages was between 16 and 75 years,
with the mean age equal to 40.2 + 10.5 years. Prevalence of abnormal Pap smears was 9.8% in HC and 9.4% in NHC (p-
value = 0.90). HC showed atypical change (ASC, AGC), low-grade squamous intraepithelial lesions (LSIL) and high-grade
squamous intraepithelial lesions (HSIL) at 0.8%, 1.6% and 7.4%, respectively. NHC had an incidence of atypical change,
LSIL and HSIL at 0.8%, 0.8% and 7.8%. HC had an equal incidence of abnormal Pap smears prevalence to NHC. Further,
the percentage of HC and NHC groups with histological confirmed cervical intraepithelial neoplasia (CIN) 1 were not
significantly different (4.92% vs. 6.25%, p-value = 0.70), likewise CIN 2/3 (1.64% vs. 1.56%, p-value = 1.00). According to
our study the rate of abnormal Pap smears observed in both health care providers and clients was essentially the same.
Conclusions: The prevalence of abnormal Pap smears in health care providers was statistically equivalent to that in their
clients.
Keywords : Abnormal Pap smears, Prevalence, Health care providers, Liquid-based.
