I. Discussion
Cervical cancer is the leading cause of cancer-related deaths among women in the world as well as in Vietnam. Until 1993, Vietnam was one of many developing countries to which Pap smear screening programs were virtually nonexistent.
The Viet/American Cervical Cancer Project, initiated in 1993 by physicians in Vietnam and the United States, supports the development of a comprehensive, cost-effective cervical cancer preventing program in Ho Chi Minh City and in Hanoi
The results shows that 7.7 out of 100,000 women were estimated to have cervical cancer in Hanoi and 26.8/100,000 in Ho chi Minh City .
There hadn’t been any research or program on cervical cancer prevention in HUE until 1999 when ERIC SUBA, director of the The Viet/American Cervical Cancer Project made a intergrated Research with the participation of Vietnamese Association of Midwives, Hanoi Medical University and Hue Central Hospital in 1999 .The research was made among 10,592 women living in the city, coastal, and mountainous areas.
II. Objectives
• Early detection of cervical cancer in the community in order to prevent cervical cancer.
• Explore the role of midwives in the contribution of early detection of cervical cancer program.
• Early detection of cervical cancer by PAP (Papanicoleou) Staining Method
III. Subjects and Methodology
• Subjects : 17.272 women aged from 30 – 55
• Methodology:
+ For the first step ,the Vietnamese Association of Midwives establish 4 mobile teams and sent them to the community to educate, counsel and convinced the women in the target areas to participate in the program.
+ The next step is to collect the samples, fixed on the slides and bring them to the RH Center of the Association for Papanicoleou staining.
After staining, all the slides were sent to the Pathology Department of Hanoi Medical School, the slides were read by the cytologists who are the professors of the school.
+ All the abnormal cases were sent back to HUE Central hospital for biopsy. The biopsies were done by the gynecologists and were read by the cytologists of Hue Central Hospital.
+ All the abnormal biopsy cases were read again by the American cytologists.
+ After the final diagnosis, the patients were sent to HUE central hospital for treatment.
IV. Target areas
• City
• Plain
• Mountainous areas
• Coastal areas
| No. |
Areas |
Cases |
Rate % |
| 1 |
Hue City |
3029 |
17,54 % |
| 2 |
Huong Tra |
4354 |
25,21 % |
| 3 |
A luoi, Nam Dong, Phong Dien |
838 |
04,85 % |
| 4 |
Phu Vang, Phu Loc, Huong Thuy, Quang Dien |
9051 |
52,40 % |
| Total |
17.272 |
100% |
V. Results
| No. |
FINDINGS |
Cases |
Rate % |
Cases / 100.000 p |
| 1 |
Normal |
1399 |
08.10 % |
8099 |
| 2 |
Inflamation |
15197 |
87.98 % |
87882 |
| 3 |
Ascus( Atypical squamous cells of undetermined significance) |
370 |
02.14 % |
2142 |
| 4 |
AGUS(Atypical glandular cells of undetermined significance) |
57 |
00.33 % |
330 |
| 5 |
LSIL (Low-grade squamous intraepithelial lesion) |
181 |
01.05 % |
1048 |
| 6 |
HSIL(High-grade squamous intraepithelial lesion) |
65 |
00.38 % |
376 |
| 7 |
Cancer |
3 |
00.02 % |
17 |
| Total |
17.272 |
100% |
|
-Age of 370 cases in Ascus (Atypical squamous cells of undetermined significance )
| No. |
Age |
Cases |
Rate % |
| 1 |
30 – 35 |
39 |
10,5 % |
| 2 |
36 – 40 |
87 |
23,5 % |
| 3 |
41 – 45 |
98 |
26,5 % |
| 4 |
46 – 50 |
129 |
34,9 % |
| 5 |
51 - 55 |
17 |
4,6% |
| Total |
370 |
100% |
-Age of 181 cases in LSIL (Low-grade squamous intraepithelial lesion).
| No. |
Age |
Cases |
Rate % |
| 1 |
30 – 35 |
17 |
9,4 % |
| 2 |
36 – 40 |
42 |
23,2 % |
| 3 |
41 – 45 |
51 |
28,2 % |
| 4 |
46 – 50 |
57 |
31,5 % |
| 5 |
51 - 55 |
14 |
7,7 % |
| Tổng cộng |
181 |
100% |
- Age of 65 case HSIL ( High-grade squamous intra-epithelial lesion )
| No. |
Age |
Cases |
Rate % |
| 1 |
30 – 35 |
1 |
1,5 % |
| 2 |
36 – 40 |
4 |
6,2 % |
| 3 |
41 – 45 |
14 |
21,5 % |
| 4 |
46 – 50 |
26 |
40,0 % |
| 5 |
51 - 55 |
20 |
30,8 % |
| Total |
65 |
100% |
• The high risk lesions ( ASCUS, AGUS. LSIL, HSIL)which can lead to cancer occurred among the women aged ranging from 30 - 55 , with the rate 2.90 % .
• The rate of cancer account for 0,02 %, means that there are 17 women suffering from cervical cancer per 100,000 population.
The results of 215 biopsy cases.
| No. |
FINDINGS |
Cases |
Rate % |
| 1 |
Normal |
35 |
16,3 % |
| 2 |
Inflamation |
127 |
59,0 % |
| 3 |
CIN I ( Mild dysplasia) |
21 |
9,8 % |
| 4 |
CIN II ( Moderate dysplasia) |
18 |
8,4 % |
| 5 |
CIN III ( Severe dysplasia) |
11 |
5,1 % |
| 6 |
Cancer |
3 |
1,4 % |
| TOTAL |
215 |
100 % |
VI. Discussion
• Our research showed that 2.90 % of milf abnormal cases (ASCUS, AGUS, LSIL, HSIL) fall on the women aged ranging from 30 – 55
• This result makes us think that the Pap Screening in the community is very necessary in order to prevent cervical cancer.
• The rate 0.02% means that 17/100,000 p suffer from cervical cancer. Comparing with the research made in Ha Noi by Nguyen Ba Duc, the rate of cervical cancer in HUE is 3 time higher than Hanoi and comparing with the research in Ho Chi Minh City made by Nguyen Chan Hung it is nearly the same ( 26.8/100,000p).
• The research is meaningful enough to launch an Early Cervical Cancer Prevention program in the coming years.
VII. Evaluation on the role of Midwives in the research
• Midwife is the first person who perform the gynecological exam and collect the samples.
• The midwife knows how to educate and counsel the women to participate in the program.
• Midwives are present in most of the Communal Health Centers.
• If being trained, midwives can do good Papanecoleou staining .( In our Research, it was the midwives, who were trained to do Pap staining, stained the slides .
• Thus, midwives play an important role in our research and we think that any community-based Program on Early Detection of Cervical Cancer should have the participation of midwives.
VIII. Conclusion
Our research showed that 0.02% out of 17,272 were cancer ( 17/100,000p).The abnormal cases which can lead to cancers are ASCUS, AGUS, LSIL, HSIL : 2.90% ( 3896/100,000P).
Early detection of cervical cancer by Papanicoleou staining is very meaningful to early prevent and treat cervical cancer for women in time.
With the goal to early detect cervical cancer in the community in order to contribute to the “ Prevention Of Cancer Strategy “ in Vietnam , all activities for this program should be well organized and effective , especially there must be the direction of the Local Department of Health and the collaboration of the relevant organizations.
Dr. PhD. Nguyen Van Bang
Hue Central Hospital
