Screening for cervical cancer in an African setting

ObjectiveTo estimate the proportion of women who were screened for cervical neoplasia with Papanicolaou (Pap) smears in 2002 in the Free State province of South Africa, and determine whether progress had been made since 1985.MethodsA cross-sectional survey was done using 1887 smears, which represented 5% of the 37,749 smears examined at the 7 laboratories serving the province in 2002.ResultsExtrapolating the results to the census data for 2002, Pap smears were taken in 4.1% of the female population aged 15 to 65 years during that year. The rates were 18.8% for white women, most of whom use private medical services, and 2.6% for black women, almost all of whom use public medical services. In 1985, in a similar study found that 7.1% of the female population was screened with Pap smears, which means that cervical screening decreased by 42% over the 17 years (P ≤ 0.0001; 95% confidence interval, − 3.1% to − 2.9%).ConclusionIn view of the deterioration of cervical screening services documented in this study, it seems unlikely that Pap smear screening will succeed in Africa.