Utility of Pap Smears and Mammograms in Midlife Urban Malaysian Women
Utility of Pap Smears and Mammograms
Abstract
Cancers of the breast and cervix made up 30.4% and 12% of all cancer cases in Malaysia. Thus screening for reproductive organ cancers as women approached menopause becomes exceedingly important. The study reports the baseline assessment tests of 495 disease free urban Malaysian women aged 45 years and above who volunteered in a healthy lifestyle intervention study. The sample comprised of 58.0% premenopaused and 42.0% postmenopaused women with an average age of 51.27±5.35 years old. Over two thirds were Chinese followed by Malays and Indians. Overall, abnormal Pap smears
were seen in 7.6% comprising of 1.3% cervical intraepithelial neoplasia (CIN), 6.1% human papilloma virus (HPV) infection and 0.2% atypical squmous cells of undetermined significances (ASCUS). Yeast and other infections were found in 6.9% and 1.9% respectively. Comparatively, postmenopausal women had a 2.8 fold higher cancerous changes whereas premenopausal women had a higher infection rate, 11.8% vs. 4.7% respectively (p=0.024) with comparable HPV infection rates in both. This study found 1.3% had breast cancer (BC) with 3.6% requiring a biopsy while 3.4% needed regular follow up. Postmenopaused women had more abnormal mammograms (p<0.0005) of a graver nature, requiring monitoring although the rate of BC was lower than the premenopaused, 0.010 versus 0.015. The findings identified better vigorous screening for malignant carcinoma of the cervix in postmenopausal women as the incidence was higher. As for breast abnormalities, screening should begin at an earlier age, amongst pre- and postmenopausal women from 45 years old and above.
Keywords :
Mammogram,
Pap Smears,
Abstrak
Kanser payu-dara dan kanser serviks merangkumi 30.4% dan 12% kesemua kes kanser di Malaysia. Oleh demikian saringan kanser organ reproduktif pada ketika wanita mendekati menopaus adalah penting. Kajian ini melapurkan hasil penilaian kemasukan 495 wanita kawasan bandar Malaysia berusia 45 tahun ke atas yang telah mengambil bahagian dalam projek gayahidup sihat secara sukarela. Mereka terdiri daripada 58.0% wanita premenopaus dan 42.0% posmenopaus dengan min umur 51.27±5.35 tahun. Lebih dua pertiga terdiri dari kaum Cina diikuti oleh Melayu dan India. Pada keseluruhan, calitan Pap abnormal didapati pada 7.6% iaitu 1.3% cervical intraepithelial neoplasia (CIN), 6.1% infeksi human papilloma virus (HPV) dan 0.2% atypical squmous cells of undetermined significances (ASCUS). Infeksi yis dan lain organisma dijumpai pada 6.9% dan 1.9% masing-masing. Wanita posmenopaus menunjukkan 2.8 kali ganda insiden kanser serviks sementara wanita premenopaus mempunyai kadar infeksi yang lebih tinggi, 11.8% lawan 4.7% (p=0.024). Kadar infeksi HPV adalah setara pada kedua-dua kumpulan. Kajian ini mendapati 1.3% mengidap kanser payu-dara, 3.6% memerlukan biopsi dan 3.4% perlu pemantauan berkala. Wanita posmenopaus memiliki lebih mamogram abnormal (p<0.0005) jenis merbahaya yang memerlukan pemantauan. Akan tetapi kadar kanser payu-dara adalah lebih rendah pada posmenopaus berbanding kepada premenopaus, 0.010 lawan 0.015. Hasil kajian ini telah mengenalpasti saringan aktif kanser serviks dikalangan wanita posmenopaus kerana kadar kanser adalah lebih tinggi. Untuk mengesan perubahan abnormal payu-dara, proses saringan harus bermula lebih awal, di kalangan wanita pre- dan posmenopaus yang berusia 45 tahun ke atas.
Kata Kunci :
Calitan Pap,
Mamogram,
Correspondance Address
Professor Dr Nafisah Adeeb, Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia. Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Email:naadeeb@mail.hukm.ukm.my
