Carcinoma of the uterine cervix: results of Ka-Ngwane screening programme and comparison between the results obtained from urban and other unscreened rural communities.

Objective: The Ka-Ngwane screening programme was initiated by the Department of Anatomical Pathology and the Department of Community Health at Medunsa to establish the incidence of cervical intraepithelial neoplasia (CIN) and cervical carcinoma (CaCx) in previously unscreened rural population in our catchment area.

Study Design: Ten thousand consecutive PAP smears from Ka-Ngwane (Mpumalanga) area are the subject of the analysis. The incidence of CIN I-CIN III and CaCx is calculated in the screened material. The changes are related to age, age of first pregnancy and parity of the patients. The incidence of cervical abnormalities is compared with 20,000 consecutive cases from Pretoria and 18,000 consecutive cases from previously unscreened rural population of Transkei.

Results: Positive cases consisted of three per cent in Ka-Ngwane, five per cent in Greater Pretoria area and of more than six per cent in Transkei. CaCx constituted 12.35% of all positive cases for Ka-Ngwane, 4.8% for urban population and 26% of Transkei positive cases. More than 75% of positive cases in Ka-Ngwane were below 40 years of age and five cases of CaCx were found in the 21-30 year age group. In Pretoria more than 80% of positive cases were younger than 41 years. In the material from Transkei similarly 80% of the positive cases were younger than 41 years.

Conclusion: The screening programme confirmed the high incidence of CIN and CaCx in previously unscreened population and an urgent need to develop educational programme which will facilitate early detection, proper treatment and follow up of the cases with cervical pathology. CaCx was found at a younger age than in the developed countries which indicated that screening programmes in our environment should involve all adult females from the age of 25 years.