Cervical cancer is the fifth leading cause of cancer death in women worldwide, but the second leading cause of cancer death in women in low-income countries (WHO report 2006). The incidence and mortality from cervical cancer in the developed countries has decreased steadily over the past 40 year, primarily due to pap's smear screenings.

Pap's Smear Test

Pap smear is an important screening tool for the early detection of cervical cancer where a sample of cells are taken from the cervix by a trained doctor or nurse, and examined under a microscope. The test detects cancer cell of the cervix. It is also useful in detecting other abnormal cells. The abnormal cells called cervical dysplasia. If it is left untreated, the cells could grow further and over time becomes cancerous. If women had regular Pap smear test, 90% of cervical cancer would be prevented.

Pap Smear screening program was launched in 2004 by RHSTEP.  A study was conducted on Pap's Smear program during the period of July 2004 to March 2007 and total 26867 clients received Pap smear test from the RHSTEP center in this period.

Age distribution of Pap's Smear clients

Marital status of Pap's Smear clients	Parity of clients

In the study, most of clients within 25 – 34 yrs (27% 25 -29 yrs age and 24 % 30 – 34 yrs age) age are selected for Pap's smear test. Married women are significantly received more than unmarried and divorced women due to more married women are examined for MR and other reproductive health services than unmarried or divorced women. The women who have four or more children are identified for pap's smear screening test than the women who have one, two or three children.

Pap's Smear Test among MR clients :

..Here showed that 74% Pap's smear screening test delivered to those clients who came to center for Menstruation regulation and 26% clients didn't come for MR service. So, a large group who are identified for Pap's Smear test came to center for getting service other than MR service .

Clients of vaginal discharge	Clients of abdominal pain

Women are selected more for screening test of cervical cancer (Pap's Smear test) that have vaginal discharge and lower abdominal pain than those with no history of vaginal discharge and no lower abdominal pain.

Contraceptive use by clients

Those clients are identified more for pap's smear screening test that use oral contraceptive pill than those of other contraceptive method users. There are several studies that cervical cancer risk increase when Oral Contraceptives (OC) are used for a long time. Women, who take OC, as others, should be screened regularly.

Education status of clients

Here showed that the proportionate difference among identified clients for Pap's Smear is least. So, education could not influence on cervical cancer. Educated and no educated all women can identify for this test  

Pap's Smear results of the clients

From this study it is explained that the women who are receiving Pap smear service from the clinics, significant portions (94%) of them are suffering from different types of inflammations (mild, moderate and severe inflammation). The Pap smear facility has helped to diagnose and offer appropriate treatment for those women. Women with malignancy and abnormal cells are referred for further specific investigation, specific treatment and further follow up from the clinic. Without this program they may remain unscreened and subsequently lead to develop more serious complications and at later stage may develop cervical cancer. So the Pap smear service is contributing to awareness, prevention as well as treatment for carcinoma in situ.

All women who have had sexual intercourse are potentially at risk because they might have been infected with HPV. Cervical cancer is most commonly found in women in their 40s and 50s. The women most at risk are those who have never been screened, had sexual intercourse and children at a young age, have had more than 5 children, have multiple partners or partners who have multiple partners, and smoke tobacco.

Pap's smear test is one of the most important cervical cancer screening tests. A Woman between the ages of 25 and 65 years (or according to national norms) should have a screening test. Early detection, early treatment can save many lives.  

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