Cervical Cancer Screening in an Early Diagnosis and Screening Center in Mersin, Turkey

  • Nayir, Tufan (Mersin Public Health Directorate) ;
  • Okyay, Ramazan Azim (Tokat Directorate Of Health) ;
  • Nazlican, Ersin (Department of Public Health Cukurova University Faculty of Medicine) ;
  • Yesilyurt, Hakki (Ministry Of Health) ;
  • Akbaba, Muhsin (Department of Public Health Cukurova University Faculty of Medicine) ;
  • Ilhan, Berrin (Mersin Public Health Directorate) ;
  • Kemik, Aytekin (Mersin Public Health Directorate)
  • Published : 2015.11.04


Cancer is a major public health problem due to the jeavy disease burden, fatality and tendency for increased incidence. Of all cancer types, cervical cancer is reported to be the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases worldwide in 2012. It features a long preclinical phase with slowly progressing precancerous lesions such as CIN 2 and 3 and adenocarcinoma in situ. Therefore, screening programs such as with Pap smear tests may play an important role in cervical cancer prevention. The purpose of this study was to present results of a Pap smear screening survey for cervical cancer targeting women living in an urban area in the province of Mersin, located in the Mediterranean region of Turkey. This community-based descriptive study included women living at Akdeniz county of Mersin province. A total of 1,032 screened women between 30 and 65 ages within the routine screening programme constituted the study population. The mean age of the participants was $43.8{\pm}8.6$ (min. 30, max. 65) years. The percentage of the participants who had previously undergone smears was 40.6%. Epithelial cell changes were found in 26 (2.5%) participants, with ASC-US in 18 (1.7%), ASC-H in 2 (0.2%), LSIL in 5 (0.5%) and HSIL in 1 (0.1%). The most common clinical presentation together with epithelial changes was abnormal vaginal discharge. Taking into account the presence of women who had never undergone Pap test; it should be offered at primary level of health care in the form of a community-based service to achieve reduced morbidity and mortality rates.


Cervical cancer;pap smear;prevention;cancer screening;community


  1. ACOG (American College of Obstetricians and Gynecologists) (2009). ACOG practice bulletin. No:109-2009. Obstet Gynecol, 114, 1409-20.
  2. Akgun Sahin Z, Tan M, Polat H (2013). Hopelessness, depression and social support with end of life Turkish cancer patients. Asian Pac J Cancer Prev, 14, 2823-8.
  3. Ali F, Kuelker R, Wassie B (2012). Understanding cervical cancer in the context of developing countries. Ann Trop Med Pub, 5, 3-15
  4. Apgar BS, Zoschnick L, Wright TC Jr (2003). The 2001 Bethesda System terminology. Am Fam Physician, 68, 1992-8.
  5. Banik U, Bhattacharjee P, Ahamad SU, Rahman Z (2011). Pattern of epithelial cell abnormality in Pap smear: A clinicopathological and demographic correlation. Cytojournal, 8, 8.
  6. Chen YY, You SL, Chen CA et al (2009). Effectiveness of national cervical cancer screening programme in Taiwan: 12-year experiences. Br J Cancer, 101, 174-7.
  7. Demirhindi H, Nazlican E, Akbaba M (2012). Cervical cancer screening in Turkey: A community-based experience after 60 years of Pap smear usage. Asian Pac J Cancer Prev, 13, 6497-500.
  8. Duggan MA, Khalil M, Brasher PM, Nation JG (2006). Comparative study of the thinprep pap test and conventional cytology results in a canadian cohort. Cytopathology, 17, 73-81.
  9. Elovainio L, Nieminen P, Miller AB (1997). Impact of cancer screening on women’s health. Int J Gynaecol Obstet, 58, 137-47.
  10. EroGlu C, Unlu Y, Eryilmaz MA, GOnenc O (2008). Konya egitim ve arastirma hastanesi Kanser Erken Teshis-Tarama ve Egitim Merkezi servikovajinal smear tarama deneyimi (Cervicovaginal smear screening experience early cancer diagnosis-screening and education center konya education and research hospital). Jinekoloji-Obstetrik ve Neonatoloji Dergisi. Mart 2008.
  11. Ferlay J, Soerjomataram I, Ervik M, et al (2014). GLOBOCAN 2012 v1. 0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Visit:
  12. Fiscella K, Franks P (1999). The adequacy of Papanicolaou smears as performed by family physicians and obstetriciangynecologists. J Fam Pract, 48, 294-8.
  13. IdestrOm M, Milsom I, Andersson-EllstrOm A (2002). Knowledge and attitudes about the pap-smear screening program: a population-based study of women aged 20-59 years. Acta Obstet Gynecol, 81, 962-7.
  14. Karabulutlu O (2013). Evaluation of the Pap smear test status of Turkish women and related factors. Asian Pac J Cancer Prev, 14, 981-6.
  15. Kaya M (2009). Halk sagligi yaklasimiyla servikal kanser (Cervical Cancer with Public Health Perspective) (Ed. Akin A.) HUKSAM Yayinlari, Ankara.
  16. Kulig B, Lukaszek S, Brucka A, et al (2006). [Comparative analysis of abnormal Pap smear and the results of histopathological examination of specimens from the cervix of the programme in-depth diagnosis cervical cancer conducted at the of Operational Gynecology Department ICZMP in Lodz]. Ginekol Pol, 81, 828-33.
  17. Mehmetoglu HC, Sadikoglu G, Ozcakir A, Bilgel N (2010). Pap smear screening in the primary health care setting: a study from Turkey. N Am J Med Sci, 2, 467-72.
  18. Ojiyi E, Dike IE, Okeudo C, Ejikem C, Nzewuihe A, Agbata A (2013). Local risk factors in genital human papilloma virus infection in cervical smears. Ann Med Health Sci Res, 3, 529-35.
  19. Ozdemir O, Bilgili N (2010). Knowledge and practices of nurses working in an education hospital on early diagnosis of breast and cervix cancers. TAF Prev Med Bulletin, 9, 605-12.
  20. Oner S, Demirhindi H, Erdogan S, Tuncer I, Akbaba M (2004). Gynecologic examination fidings and Pap smear screening results of women in Dogankent, Turkey. Turkish J Public Hlth, 2, 85-91.
  21. Ozgul N (2010). The state of cervical cancer in turkey and cervical cancer screening studies. in: cancer control in Turkey (Eds.Tuncer AM (chief), Ozgul N, Olcayto E, Gultekin M). Republic of Turkey, Ministry of Health, 777, 379-84.
  22. Sankaranarayanan R (2014). Screening for cancer in low- and middle-income countries. Ann Glob Health, 80, 412-7.
  23. Saraiya UB (2003). Preventable but not prevented: the reality of cervical cancer. J Obstet Gynaecol Res, 29, 351-9.
  24. Sengul D, Altinay S, Oksuz H, Demirturk H, Korkmazer E (2014). Population-based cervical screening outcomes in Turkey over a period of approximately nine and a half years with emphasis on results for women aged 30-34. Asian Pac J Cancer Prev, 15, 2069-74.
  25. Sevil S, Kevser O, Aleattin U, Ozlem D (2013). The frequency of having pap-smear tests among women between 15-64 years old and the evaluation of the level of their knowledge. J Pak Med Assoc, 63, 873-7.
  26. Singh V, Sehgal A, Luthra UK (1992). Screening for cervical cancer by direct inspection. British Medical Journal, 304, 534-5.
  27. Solomon D, Breen N, McNeel T (2007). Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines. CA Cancer J Clin, 57, 105-11.
  28. Stewart BW, Kleihues P (Eds) (2003). Cancers of the female reproductive tract. World Cancer Report, IARC and WHO. IARC Press, Lyon, France. [] Last accessed: 15 February 2015.
  29. Turkish Cervical Cancer And Cervical Cytology Research Group (2009). Prevalence of cervical cytological abnormalities in Turkey. Int J Gynaecol Obstet, 106, 206-9.
  30. Turkish Ministry of Health (2009). Kanser erken teşhis, tarama ve egitim merkezi el kitabi (national (turkish) handbook for early diagnosis, screening and education center for cancer) (2009) [] Last accessed: 18 February 2015.
  31. Vaidya A (2003). Comparison of Pap test among high and nonhigh risk female. Kathmandu Univ Med J (KUMJ), 1, 8-13