Abstract:
The objective of cervical cancer screenll1g IS to reduce cervical cancer incidence and
mortality by detecting and treating precancerous lesions. Conventional cytology is the most
widely used cervical cancer screening test. Although cytology has been effective In reducing
the incidence and mortality of cervical cancer in developed countries in both opportunistic
and -more dramatically- organized national programs, it has been less successful and largely
ineffective in low resource settings where it has been implemented. Liquid-based cytology,
testing for infection with oncogenic types of human papillomaviruses, visual inspection with
3-5 percent acetic acid, and magnified visual inspection with acetic acid, and visual
inspection with lugol's iodine have been evaluated as alternative tests. The test
characteristics, and the applications and limitations in screening, are discussed with an
emphasis on the work of the Alliance for Cervical Cancer Prevention over the past 5 years.
Screening involves application of a relatively simple, inexpensive test to a large number of
asymptomatic people in order to classify them as likely or unlikely to have the disease of
interest. Screening positive persons are then subjected to further investigative/treatment
procedures. The objective of cervical cancer screening programs is to reduce cervical cancer
incidence and mortality by treating and detecting precancerous lesions. It is well established
that invasive cervical carcinomas develop from preexisting. slowly progressll1g
intraepithelial lesions. The direct precursor to invasive carcinomas High grade squamous
intraepithelial neoplasia grades 2 and 3(CI 2-3), one third to one half which may progress to
cervical carcinoma over 10-15 years. Most low grade intraepithelial lesions (USILs) regress
spontaneously. Adenocarcinoma in situ (AIS) is the precursor lesion for invasive
adenocarcinoma. Conventional cervical cytology is the most widely used cervical screening
test. In general all cervical screening test, predominantly detect cervical squamous lesions
and are of limited value in the detection of glandular precursor lesions as a result of
difficulties in sampling and visualizing the endocervical canal, as well experience among
readers in recognizing Adeno carcinoma insitu. The diagnostic accuracy of cervical smears
depends on adequate sampling of the transformation zone of the cervix. An adequate sample
of this area should contain endocervical cells. Aylesbury spatula has a pointed end, when
inserted in to the endocervical canal and over come this difficulty to some extent. However
small areas of abnormality may still be missed if the spatula is not in contact with the tissue
at all times, for example when the cervix is irregular and scarred. Endocervical and
ectocervical samples should be taken to achieve the best possible chance of detecting
abnormalatis.2 Dual sampling of the endo cervix and ectocervix using a brush together with
a conventional spatula has been shown to improve the quality of cervical smears2 .
However, this involves taking two samples and inevitably takes longer. The aim of this
study was to assess whether the use of one of the newer smear taking devices provides
higher percentage of smears containing endocervical cells than the Aylesbury spatula. The
Cytobrush was chosen because it is designed to be used in endocervical canal. Combination
would increase its acceptability to general practice. There is good evidence of its efficac/.
The cervical brush is a device with central fronds which project 10 mm beyond the shorter
outer fronds and is 20 mm in length. This means that the squamocoloumnar junction which
is on average 8-13 mm proximal to the tip of the cervix should be sampled in most women.