1. The incidence of significant lesions
on the cervical smears in women
under 30 years of age in Cape Town
 Dr. Genevieve Warner Learmonth, FF Path Anat (SA)
 Dr. Despina Learmonth, D Psych*
 Nic Low, Medical Student
Yvonne Parfitt Cancer Research Cytology Laboratory,
Groote Schuur Hospital, and
 *Department of Health Psychology,
 University of Cape Town, South Africa

2. Cervical Cancer in South Africa
 In South Africa asymptomatic women
under 30 years are not offered a free
cervical smear.
 Invasive Cervical Cancer (ICC) is the
second most common cancer in SA.
 Recent figures: Lifetime risk of
developing ICC is 1:31 for SA women.
 60% of these will die from this easily
preventable disease

3. History of Guidelines for cervical
screening in South Africa
 In 2001 It was argued that cervical screening at three
year intervals from time of sexual debut was
impractical: healthcare resources could be better spent
on screening high risk groups only.
 This, despite a report in 1990 of a peak incidence of
CIN3 ( HSIL) and ICC in women aged 20-30 years.
 Current National Screening Policy: a free smear at age
30, 40 and 50 years of age

4. Young women in SA
 The age of sexual debut amongst women in SA is 16.9 years.
 This puts them at risk for sexually transmitted infections
including Human Papilloma Virus and Human
Immunodeficiency Virus.
 HPV is critically linked to the development and
progression of pre-invasive cancerous lesions of the cervix.
21% of SA women are HPV positive.
 The peak incidence of HIV infection in SA is in women
aged 25 -29. HIV destroys immune function facilitating
persistence of infections.
 HIV intensifies progression from HSIL to ICC.

5. METHOD
Data on cervical smears from the computerised records at
Groote Schuur Hospital Cytopathology Laboratory for 2010 to
2011 :
Total & age specific prevalence of women who had a cervical
smear were calculated.
The number of women who were referred to Colposcopy for
treatment of suspicious lesions, HSIL, and 3 consecutive LSIL
The incidence of HIV infection in this group of women is
unknown.

6. Results
 Total smears in 2010-2011: 108,542
Total Women under 30yrs: 23,317 (21%)
Total Women ref. to Colposcopy: 3080
 Total Women under 30yrs to Colp: 577 (19%)
COLPOSCOPY INCIDENCE
Women 30yrs and older: 28 per 1000 smears
 Women under 30yrs: 25 per 1000 smears

7. Absolute number of smears
With proportion under 30 yrs
Percentages of women under
30 and over 30 at colposcopy

8. Colposcopy at GSH ( 2010 -20110

9. Significant lesions on smears in the
UK, for comparison with Cape Town

10. Economic and psychosocial impact
 The overall psychosocial and early impact of preventable
Invasive Cancer of the Cervix is considerable:
 Five year survival for women with ICC is:
 Stage I :80% Stage II: 50%, Stage III: 30% Stage IV: 15%
The higher the clinical stage the more radical the
surgery and prolonged radiotherapy, resulting in
considerable morbidity with risk of recurrence.
 Loss of employment and reproductive function
Loss of young mothers with school going children.
 Motherless children do not gain equal education as
their peers, and so enter the cycle of poverty.

11. Conclusion
 These results from GSH in South Africa suggest that
“first time” cervical screening at 30 years could be too
late to identify many young women with HSIL and ICC
 Currently disadvantaged women are not invited for
free screening before the age of 30yrs despite all the
predisposing factors and documented evidence of the
alarming risk of morbidity and mortality from this
preventable cancer in young women.
An urgent review of the National Guidelines for Cervical
Screening is imperative.