Perceived Barriers to Cervical Cancer Screening Using Pap Smear Test among Women Attending Saad Abu Al Ella Hospital in Khartoum State, 2022

Background: Cervical cancer is the second common cancer among women worldwide. It is a preventable cancer, and early detection of precancerous conditions through the Papanicolaou cytology screening (Pap smear) is a key aspect of prevention;it is accepted worldwide as an efficient tool for secondary prevention. While the PS test is simple, inexpensive, and relatively reliable as a method of diagnosing cervical cancer, most women do not take the test. Therefore, this study is sought to describe the barriers to pap smear uptake among Sudanese women. Materials and Method: This total coverage observational, analytical and cross sectional, hospital-based study was conducted in Saad Abu El Ella Hospital in April 2022. The study was conducted using an anonymous questionnaire to assess the perceived barriers of 93 participants. All data were computerized using Microsoft Excel’17 and the data were described and analyzed using statistical package for social science (SPSS23). Results: The findings revealed that the mean age of the participants was 39.5 years and only 3.2% had ever undergone a pap smear test. Identified barriers were lack of information, not knowing where to go, and fear of pain. The majority, 72% are willing to routinely perform a pap smear test if well informed about it. The study also demonstrates that there is a significant correlation between perceived barriers score and willingness to perform the pap smear test (p value = 0.008), and between the perceived barriers score and the sociodemographic factors: Age (p value = 0.006), educational level (p value = 0.028) and occupation (p value = 0.040), but no association with the economic status was found (p value = 0.378). Conclusion: The detection rate is too low compared to the national target of over 70%. Therefore, more work is needed to reduce perceived barriers to cervical cancer screening by providing education/raising for popular awareness;addressing misconceptions and false beliefs;informing women about the necessity and importance of Pap smear;and health promotion using mass media such as national television, social media, radio, billboards, and newspapers and other print media.

Screening of premalignant and malignant cervical lesions in underdeveloped countries by using Pap smear as routine investigation in outpatient department

Objective: Papanicolou (Pap) smear screening has dramatically reduced the incidence of invasive cervical cancer worldwide. Pap smear screening is still not widely available in developing countries and therefore cannot be used as mass screening tool. This study was designed to establish the role of Pap smear as a routine investigation for females presented to gynecological department. Methods: It was a hospital based study. Patients attending with complaints including irregular vaginal bleeding, vagina discharge, dyspareunia, low backache or lower abdominal pain and primary or secondary infertility were included in the study. All these patients underwent pap smear. Results: Age of females was 25 to 60 years. Ninety females had dysplasia. Mild to moderate dysplasia was positive in 84 females. Six patients had severe dysplasia suspicious for squamous cell carcinoma (SCC) which was confirmed as invasive SCC on biopsy. All patients with mild to moderate dysplasia were regularly followed at 4 to 6 months. Thirty patients were lost during follow up. Forty had negative smear at 6 months, while fourteen having persistent dysplasia on repeated pap smears were referred for biopsies. Histopathology confirmed invasive SCC in five patients while chronic cervicitis was reported in nine patients. Only two of screened patients with high suspicion for cancer showed false negative results. Directed biopsies done in these confirmed invasive SCC. Conclusion: Pap smear is a useful, simple, non-invasive and reliable screening tool for cervical cancer. It may be practiced as a routine investigation in outpatients in developing countries, where mass screening is not available.

New Abnormal Cervical Cell Detection Method of Multi-Spectral Pap Smears

Considering the problem of traditional cervical cancer detection method that brings high false negative rate （FNR） and high false positive rate （FPR）, a new abnormal cervical cells detection method of multi-spectral Pap smear is proposed in this thesis, on the basis of multi-spectral microscopic imaging technology and computer automotive recognition technology. At first, image in a specific wave band is segmented according to the relationship between intensity and spectrum of each pixel. Then, multi-spectral features of each pixel are extracted making use of improved cosine correlation analysis （CCA） algorithm. Combined with the characteristic of each cell＇s area, final definition is made. Experiments have proved the new approach could identify abnormal cells efficiently as well as lower FNR and FPR.

Intelligent Classification Model for Biomedical Pap Smear Images on IoT Environment

Biomedical images are used for capturing the images for diagnosis process and to examine the present condition of organs or tissues.Biomedical image processing concepts are identical to biomedical signal processing,which includes the investigation,improvement,and exhibition of images gathered using x-ray,ultrasound,MRI,etc.At the same time,cervical cancer becomes a major reason for increased women’s mortality rate.But cervical cancer is an identified at an earlier stage using regular pap smear images.In this aspect,this paper devises a new biomedical pap smear image classification using cascaded deep forest(BPSIC-CDF)model on Internet of Things(IoT)environment.The BPSIC-CDF technique enables the IoT devices for pap smear image acquisition.In addition,the pre-processing of pap smear images takes place using adaptive weighted mean filtering(AWMF)technique.Moreover,sailfish optimizer with Tsallis entropy(SFO-TE)approach has been implemented for the segmentation of pap smear images.Furthermore,a deep learning based Residual Network(ResNet50)method was executed as a feature extractor and CDF as a classifier to determine the class labels of the input pap smear images.In order to showcase the improved diagnostic outcome of the BPSICCDF technique,a comprehensive set of simulations take place on Herlev database.The experimental results highlighted the betterment of the BPSICCDF technique over the recent state of art techniques interms of different performance measures.

Assessment of Knowledge of Cervical Cancer and Pap Smear Screening in Makurdi Metropolis

Knowledge of cervical cancer and Pap smear screening in a sample population in Makurdi metropolis was assessed using a survey design. Five hundred and seventy-four （574） participants aged 18-60 years, who were accidentally/conveniently sampled in the town, took part in the study. Of this number, 48.3% （N = 277） were males, and 51.7% （N = 297） were females and from diverse occupations. Data were collected using a standardized questionnaire, the knowledge of cervical cancer and Pap Smear Screening Scale （KCPS） with ten items. Results reveal that participants have limited knowledge on cervical cancer and Pap Smear Screening with 35.3% （N = 203） having knowledge, while 64.7% （N = 371 ） having limited knowledge. No statistical significant difference in the knowledge of cervical cancer and Pap Smear Screening between older and younger participants t （553） = -1.69; P 〉 0.05, Single and Married participants t （562） = -0.97; P 〉 0.05, low and high levels of education t （564） = -1.83; P 〉 0.05 was found. Surprisingly, males （mean = 33.55） significantly had more knowledge of cervical cancer and Pap Smear Screening than females （mean = 32.26） t （572） = 2.03; P 〈 0.05 and other participants had better knowledge than health workers t （572） = -2.43; P 〈 0.05. Enlightenment campaigns, Magazines and News papers, Television, Radio, Friends and Schools were some of the sources participants acquired knowledge of cervical cancer and Pap Smear Screening. It is obvious that knowledge of cervical cancer and Pap Smear Screening is limited among the population in Makurdi metropolis, therefore a need to intensify enlightenments and awareness campaigns targeted at all groups of people is imperative.

Evaluation of Human Papillomavirus Infection among Women Using Pap Smear and PCR in Shiraz, Iran

Human papillomaviruses （HPVs） infect mucosal and cutaneous epithelia and cause malignancy and neoplastic lesions. These viruses cause 25,000 deaths per year from cervical cancer most often in developing countries. This major public health problem makes them important targets in the researches of papillomavirus detection methods. Since the early diagnosis of this virus infection would prevent neoplasia and cervical cancer, therefore in this study the combination of molecular and cytological methods were used to show the occurrence of the infection in women referred to Baghiatollah clinic of Shiraz. The results showed out of 110 cases, two samples were positive by PCR using GP5/6 primers but Pap smears showed only one sample of abnormal cytology. The rest 108 samples were negative by PCR and had normal cytology. The samples （1.82%） in evaluated women. present study showed a low occurrence of HPV infection in cervical

Pap Smear Screening, the Way Forward for Prevention of Cervical Cancer? A Community Based Study in the Buea Health District, Cameroon

Introduction: Cancer of the cervix is the second most common gynecologic malignancy in the world due to lack of awareness and poor uptake of cervical cancer screening services especially in low income countries. In Cameroon, though there is a national cervical cancer-screening program the service has been limited to some main cities without an appreciable impact. Aims: The objectives of this study were to determine the knowledge, attitude, practice towards Pap smear screening, thus evaluating its suitability as a screening procedure in Cameroon, through this pilot study in the Buea Health District. Methods: The study was a community-based cross-sectional descriptive survey that involved 309 women. Women from 18 years were enrolled for the study from 9th?October to 20th?November 2013. Results: The mean age of the participants was 32.3 years (SD = 11.7 years). Most of the women (29.5%) who had gone for the Pap test were in the 41 - 50 years age group. Only 3.6% of the study participants had “good” knowledge of cervical cancer and Pap smear screening. Approximately 20% of the women had a previous Pap smear test with 55.7% of them having the test just once. Eighty two percent of those who had secondary and tertiary levels of education had never had a Pap smear test. Awareness of risk factors for cervical cancer was low. Fear of pain, positive results after screening, non-curability of cervical cancer were some factors associated with a low Pap test uptake (p < 0.05). Conclusion: There is poor knowledge and perceived barriers by women about Pap smear screening and follow-up services. For an impact to be made in the prevention of cervical cancer, Pap smear screening is not the preferred method because of these limitations in this community.

Diagnostic value of the combination of TruScreen and Pap smear in screening cervical epithelial lesions: Does it add advantages over the Pap smear alone?

Introduction: Pap smear is a well known test in screening of epithelial cell abnormalities of the cervix. However, adding other screening methods to this test may increase the sensitivity and specificity of case finding. Current study has been designed to assess the sensitivity and specificity of the combination of Tru-Screen and Pap tests in comparison to Pap smear alone in women referred for annual screening. Methods: This case-control study was conducted in two groups of 66 and 73 women with epithelial cell abnormality and normal results on Pap smear, respectively. Both groups were subsequently tested with Tru-Screen and colposcopy. Positive finding in any of the three studies made the patient candidate for biopsy as the standard diagnostic test. SPSS software was used to analyze sensitivity, specificity, positive predictive value, and negative predictive value of TruScreen, Pap smear, colposcopy and the combination of TruScreen and Pap tests. Results: 105 out of 139 women underwent biopsy. Of these, 32 (30.5%) had abnormal result in biopsy. Combination of True screen and Pap smear led to a sensitivity of 93.8% and specificity of 79.5% which means an improvement in both parameters. False negative rate decreased to 6.3% but false positive rate increased to 82.2%. Positive and negative predictive values of the combined tests were 33.3% and 86.7%, respectively. Conclusion: Combination of TruScreen and Pap smear is associated with a significant improvement in both sensitivity and specificity for early screening of preneoplastic and neoplastic cervical epithelial lesions.

Association between Early Marriage and Other Sociomedical Characteristics with the Cervical Pap Smear Results in Iraqi Women

Background: The standard screening test for cervical cancer is the Pap smear and cervical cancer is a significant health issue worldwide. Early sexual activity, multiple sexual partnerships, parity, young age at first pregnancy and early marriage are traditional risk factors for developing cervical cancer. The aim of the present study was to assess the effect of early marriage in on the results of Pap smear in Iraqi women. Methods: A cross-sectional study was carried out on 200 women who attended the Women Health Clinic of Al-Elwiya Maternity Teaching Hospital, Baghdad for the period from November 2013 to April 2014. Data were collected through direct interview and a prepared questionnaire including patients’ characteristics and Pap smear results. Results: Mean age of studied women was 39.9 ± 11.4 years and mean age of marriage was 19 ± 5 years. Abnormal Pap results were reported in 63.5% of them. A significant association was observed between abnormal Pap smear and each of age 20 - 30 years, ≤18 years age at marriage, marriage duration >10 years, irregular menstrual cycle, tubal ligation and abnormal medical history (P < 0.05). Conclusions: Early marriage was strongly associated with abnormal Pap smear results in Iraqi women.

Prevalence of Unsatisfactory Pap Smear and Associated Clinical History and Diagnosis in a Tertiary Teaching Hospital in Ghana

Background: A major limitation of cervical cytology is the unsuitability of proportion of smears submitted for analysis and for cytological assessment (unsatisfactory). This study examines the prevalence of unsatisfactory Pap smear, clinical history and diagnosis in the Department of Pathology, Korle-Bu Teaching Hospital (KBTH), Ghana. Materials and Methods: A retrospective review of 15,290 cases spanning 12 years (2005-2016) was carried out at the cytology unit of the Pathology Department of the KBTH. Out of the 15,290 Pap smear records retrieved, 2347 reports were excluded leaving 12,943 for the study. All unsatisfactory smear cases were analyzed and categorized using the Bethesda 2001 System. Results are presented using descriptive statistics. Results: The overall prevalence of unsatisfactory Pap smear was 402 (3.1%). Routine screening smear accounted for 115 (0.9%);reports without clinical history and diagnosis gave 21 (0.2%) and cases with clinical history and diagnosis were 287 (2.2%). The common cause of unsatisfactory Pap smear was scanty cellularity 222 (1.72%). Patient’s history accounted for the least cause of unsatisfactory Pap smear 2 (0.02%). Conclusion: Pap smear results reported as unsatisfactory could harbor cancer malignancy. Samples should be taken by well-trained persons.

Cervical Cancer in Women with Inflammatory Pap Smears

In spite of preventive measures such as Papanicolaou cervical cytological analysis and, more recently, vaccination against HPV infection, cancer of the uterine cervix continues to be one of the most frequent causes of mortality among women worldwide, particularly in developing countries. In this prospective study, sixty patients with inflammatory Pap smears had a colposcopy with directed biopsies. The average age of our patients was 42 years. Results showed that colposcopy is normal in 10% of women. It showed normal transformations, ectropion, a colpotis and polyp at 8.33%, 21.66%, 13.33% and 5% respectively. It was able to detect changes with Grade I atypical transformations (28.33%), and Grade II atypical transformations in 13.33% of cases. The biopsies were objectified dysplasia and carcinoma in 24.13% of cases with carcinoma in situ, micro invasive squamous cell carcinoma and invasive carcinoma glandular. Moreover, we detected HPV-specific antibodies in sera of these patients. Results showed that six patients (10%) showed a positive reactivity to at least one of the HPV-16 or HPV-18 antigens and sera showed different reactivity to the different antigens with the following percentages: 5%, 3%, 2%, 3% and 3% for L1 HPV-16, E6 HPV-16, E7 HPV-16, E6 HPV-18 and E7 HPV-18 respectively. Among patients having positive antibody response, 83.33% were cases of dysplasia and carcinoma. We concluded that the Pap smear, examination of key screening for cervical cancer, is a screening test without diagnostic value and more specifically any inflammatory Pap smear should be considered a positive test and led to further investigations. Moreover, colposcopy is an exam that is performed on an outpatient basis;it allows a detailed study of the cervix and reduces the negative rate of cytology. In addition, early detection of HPV antibodies could help the follow-up of patients.

Knowledge of Cervical Cancer and Practice of Pap Smear Testing among Secondary School Teachers in Nnewi North Local Government Area of Anambra State, South Eastern Nigeria

Introduction: Cervical cancer is one of the commonest cancers of the female genital tract and accounts for about a hundred and ninety thousand deaths each year, most of which occur in developing countries. Early cervical screening methods have contributed to the fall of cervical cancer deaths in the developed world. This is different in developing countries where people have limited knowledge about this disease condition and the screening methods for prevention. This study determined the knowledge and practice of cervical cancer screening among female secondary school teachers in Nnewi North Local Government Area of Anambra State. Method: This was a cross-sectional descriptive study in which self-administered questionnaires were returned by 142 respondents and results were analyzed using Statistical Package for Social Sciences version 17. Results: The mean age of the respondents was 35.6 ± 1.76 years. A high proportion of the respondents were aware of cervical cancer 106 (74.6%). About 44 (41.5%) knew of cervical cancer screening by Pap smear, out of which only 20.5% had done a pap smear. The most common reasons given for not doing the test were;not deeming the test necessary, not knowing where the test could be done and feeling of not being at risk of developing cervical cancer. Conclusion/Recommendation: Though the level of awareness of cervical cancer screening was high, the level of uptake of Pap smear was still very low. A national cervical cancer Pap smear campaign should be intensified to change the negative perception towards Pap smear test.

The Social Ecology of Cervical Cancer: The Challenges to Pap Smear Screening

Cervical cancer is a preventable disease. The risk factors for the development of cervical cancer include both biologic factors and social factors. In the United States, the leading risk factor for the development of cervical cancer is not having a Pap smear for five years prior to the diagnosis of cancer. In low and middle income countries, cervical cancer incidence and mortality are directly related to the lack of both screening programs and cancer treatment facilities. This paper examines the social ecology of cervical cancer. The literature is reviewed on social and cultural barriers to access to health care and its effect of cervical cancer rates and outcomes.

Prevalence and Pattern of Abnormal Pap Smear among Pregnant Women Attending Antenatal Clinic in a Missionary Hospital in Abakaliki, Southeast Nigeria

BACKGROUND: Cervical cancer is the most common type of cancer affecting the genital tract among women in developing countries. Screening programmes have been well talked about in Nigeria, but they are not well organized. Hence, the incidence of cervical cancer does not appear to be reducing. A possible way of solving this problem is by doing an opportunistic pap smear among women attending antenatal clinics, since a good number of women do access antenatal care. OBJECTIVES: To determine the prevalence, knowledge, awareness, practice, risk factors and pattern of Pap smear among women attending antenatal clinic in Mile 4 hospital, Abakaliki. METHOD: This is a cross-sectional study carried out at the antenatal clinic of Mile 4 Hospital, Abakaliki, Nigeria. A total of 110 consecutive pregnant women who fulfilled the inclusion criteria and have given their consent were recruited into the study at the time of their first prenatal (booking clinic) visit for antenatal care. Data was collected using a questionnaire. Conventional Papanicolaou smear was taken using the standard procedure. The cytopathologic findings were documented in the questionnaire. RESULTS: Out of the 110 pregnant women who had cervical cytology by Pap smear, 7 had pre-invasive cervical lesion, giving a prevalence rate of 6.3%;5 (71.4%) were low-grade squamous intraepithelial lesion (LGSIL) while 2 (28.6%) were high-grade squamous intraepithelial lesion (HGSIL). Fifty women (45.5%) had negative smears. Inflammatory smears were seen in 50 women (45.5%). Insufficient smear was seen in 3 women (2.7%). Fifty-six women had knowledge about cervical cancer (50.9%), while thirty-six women (32.7%) were aware of a screening program for cervical cancer and only 2 women (1.8%) had been screened in the past. Hence, from this study, the population screening rate was approximately 2%. The risk factors were age of coitarche years, number of sexual partners, previous history of sexual transmitted infection, genital warts, human immune deficiency virus and use of contraceptives. CONCLUSION: The pap-smear findings among pregnant women in Abakaliki, Nigeria showed that the pre-invasive lesion of the cervix is relatively common. Pap smear should be made routine for all pregnant women.

Comparative Study of care HPV Assay,Visual Inspection and Pap Smears as Primary Screening in Rural China

农村地区的肿瘤早诊早治,一直是国家肿瘤防治工作的重点。本文旨在研究在我国农村地区,在当地现实条件下由基层技术人员操作的醋酸碘染色肉眼观察、细胞学以及careHPV DNA检测的可行性。本研究中把当地参加项目的女性随机分为3组,分别采用醋酸碘染色肉眼观察、细胞学以及careHPV DNA进行宫颈癌及癌前病变的初筛。初筛阳性的女性转诊进行阴道镜及活检。所有的检测都是有当地工作人员完成。最终诊断以中国医学科学院肿瘤医院病理专家的结果为准。同时通过问卷调查收集筛查对象及乡医村医有关HPV及筛查项目的认知和态度。最终有894名女性完成careHPV DNA检测,552名女性完成醋酸碘染肉眼观察,547名女性完成巴氏涂片。careHPV检测、醋酸碘染肉眼观察和巴氏涂片的阳性率分别为10.6%,18.1%和4.9%,差异具有统计学意义(χ~2=48.647,P<0.001)。总人群的CIN2+病变检出率为0.5%,尽管careHPV组的CIN2+病变检出率高于其他两组,但差异未发现统计学意义。通过以上研究,显示基层卫生工作人员对HPV相关知识的了解不足,但对于在国家筛查项目中引入HPV检测持积极的态度。在基层条件下由经过简单培训的实验员进行careHPV检测是可行的,应在基层卫生工作者中开展HPV及其检测相关的教育和培训。

The Reasons Why Women Do Not Participate in the Papsmear Screening and Testing Program in Sweden

Cervical cancer is the second most common type of cancer among women worldwide. In Sweden cervical cancer is the fifteenth most common cancer among women and accounts for 1.9 percent of all female cancers. The Swedish Pap smear screening program is enabling early detection of cell changes in order that treatment may be administered to prevent the development of cancerous cells. There are approximately four hundred and fifty cases of cervical cancer detected each year in Sweden and of these cases, approximately seventy five percent occur in women who do not participate in the screening and testing program. The purpose of this study was to illustrate and examine the reasons why women did not participate in the program even though they had received a notice that they had an appointment for a Pap smear test. In the study fourteen women from a district in the west of Sweden were interviewed. In order to analyse the interviews a qualitative content analysis according to Lundman and Graneheim was used. The analysis resulted in the development of three categories which were identified as communication, treatment and subterfuge (reasons or excuses for not participating). The theme of the study was the professional treatment of the women’s conditions. In the interviews the women emphasize the importance of professional treatment that is administered with respectful and sympathetic care throughout the whole healthcare system regardless of where and when the visit was conducted. Efficient organization and clear communication would minimize the inconvenience for the women during their visit.

基于全局特征引导和注意力的宫颈细胞核分割

针对宫颈细胞中正常和异常细胞核大小形态各异、细胞图像中存在干扰物影响分割等问题,本文提出一种基于全局特征引导和注意力的分割网络来提高细胞核分割精度。首先以U型网络结构作为主体,引入全局特征引导模块,充分提取各个阶段的特征获得不同层次的全局上下文信息,克服了U型网络单阶段上下文信息提取能力不足的问题以更好地处理不同形状的细胞核,提高边缘分割精度;其次,引入改进的注意门结构抑制图像中干扰物的信息,突出细胞核的信息,提高模型对干扰信息的辨别能力。在Herlev数据集上的实验结果表明,本文的方法能够有效地提高细胞核分割精度,在定量分析中Dice系数为0.9413,相较于其他方法具有一定的优势。

PAPNET计算机系统检诊宫颈抹片

宫颈癌的发病率居妇科恶性肿瘤的首位。1943年巴氏宫颈抹片法的出现,对宫颈癌的早期诊断做出了重大的贡献。传统的方法是将宫颈抹片用巴氏染色法染色,在光镜下对细胞进行逐个人工肉眼检诊,按巴氏五级分类法,对女性生殖道的恶性肿瘤进行诊断。该法工作量大,假阴性或假阳性的出现是难以避免的;并且巴氏分级法已不能适应现代细胞学的要求。 1992年美国 NSI 公司(Neruomedical Systems,Inc.)发明,并向世界推广使用了 PAPNET 计算机数字化玻片检查仪(PAPNET Computer-assisted Cytology Test,PAPNETCCT)。该装置是大型电脑自动化扫描系统,能模仿人工智能对高难度的影像进行分析。整个系统由检测中心和中间细胞室组成,可分别建立在两个不同的地方。在检测中心有一台电脑显微扫描仪及高敏显像器;中间细胞室有一套电脑解像系统及显微镜。PAPNET 的检诊分两步进行,先在检测中心由计算机对抹片上的每个细胞进行初步的辨认筛选,从每张片子上找出最可疑的128个细胞,将含有该细胞的视野用高敏显像器拍摄记录;然后在中间细胞室,由细胞学家对记录的资料进行复验,遇可疑之处,再在显微镜下进行肉眼检查。该系统按 TBS 分类法来区分各类细胞。采用 PAPNET 检诊宫颈抹片,不仅对宫颈癌检出的准确率要比传统的光镜检诊高出10倍以上,而且也可诊断宫颈癌前病变,对宫颈癌的早期筛查有着重要意义。目前,该系统在世界各国已得到广泛应用,我国已有9个城市开展了 PAPNET 宫颈抹片检诊,有多个中间细胞室,并即将建立大型检测中心。

Effect of vaginal speculum lubrication on cervical cytology and discomfort during smear examination

AIM: To evaluate the role of lubricant gel in the cytology of a Pap smear and whether it results in an improvement in the discomfort experienced by women while undergoing Pap smear screening.METHODS: A total of 151 women were analyzed in the study. After screening for inclusion criteria, a Pap smear was taken with no lubricant in all the women and the discomfort experienced was rated on a visual analogue scale. The women underwent a second Pap smear on the next visit using a lubricant gel and were again rated on a visual analogue scale for the discomfort felt. The pathologist was blinded to the fact of whether the lubricating gel was used.RESULTS: The number of unsatisfactory smears in the no gel group was 3 vs 5 in the gel group, P < 0.05. However, a significant difference(P = 0.00) was observed in the visual analogue pain score in both groups, suggesting that application of lubricant gel over the speculum improves the pain experienced by women. CONCLUSION: Using a small amount of lubricant overthe speculum does not impair cervical cytology but significantly improves the discomfort experienced by women while undergoing a Pap smear.

Cervical Cancer Prevention Challenges and Barriers to Cervical Cancer Screening and HPV Vaccinations in Ukraine and Eastern Europe

Objectives: To identify the obstacles and issues that hinder effective cancer prevention efforts in Ukraine. The study aims to provide a comprehensive assessment of the barriers to cancer prevention, including both infrastructure and behavioral factors, and identify potential solutions to address these challenges. Study Design: Comprehensive literature review. Methods: The following databases were searched: National Center for Biotechnology Information (NCBI) and PubMed (U.S. National Library of Medicine at the National Institutes of Health). The keywords used in the search included “Cervical Cancer”, “Human Papillomavirus Vaccination (HPV)”, “Ukraine”, “Eastern Europe”, “Healthcare Infrastructure in Disasters”, “Cervical Cancer Prevention”, “Pap Smear”, and “HPV Testing”. Results: A total of 3500 articles were screened. A total of 65 articles met the inclusion criteria. Limited public awareness and limited access to vaccination and screening, combined with inadequate treatment facilities lead to higher rates of cervical cancer. The COVID pandemic, war with Russia, and the Chernobyl disaster are significant factors for the low level of vaccination in Ukraine. Conclusion: The prevention and treatment of cervical cancer in Ukraine face significant challenges due to the inadequate HPV vaccination rates and screening by cytology. Efforts to improve funding and increase education of both the population and health care providers are necessary to increase interventions such as HPV vaccination, cervical cytology, and HPV testing to reduce cervical cancer rates in Ukraine.