الفهرس 
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Abstract
Cancer of the cervix is the commonest genital tract malignancy in the female. Cervical cancer has positive association with infection of human papillomavirus (HPV), and repeated or persistent HPV infections appear to raise the chances of developing the disease. Tobacco smoking, high parity, long-term hormonal contraceptive use, co-infection with Chlamydia trachomatis, herpes simplex virus type 2, HIV, immunosuppression, certain dietary deficiencies, and genetic and immunological host factors are contributing factors to cervical cancers.
The availability of effective prophylactic HPV vaccines gives new promise for a primary prevention strategy for HPV infection and cervical cancer. However, the current vaccines only protect against 70% of the disease, and are only effective for those not yet exposed to the virus. Cervical cancer incidence and mortality have declined substantially in western countries following the introduction of screening programs. Screening programs in Africa are however often rudimentary or nonexistent. The screening techniques often used are Pap smear test
Cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases in 2012. In Egypt the incidence of cervical cancer is 866 per year where mortality rate is 373 per year.
Due to the development and widespread use of cervical cancer screening tools, the incidence of cervical cancer has declined worldwide. Moreover, the detection rate of cervical intraepithelial neoplasia (CIN) has increased. Cervical cancer remains an important global public health problem. More than 85% of cases of cervical cancer occur among women in the less-developed countries.
Cervical cancer screening has been improved in developed countries over recent decades. These experiences indicate that good planning and good organization of screening programs result in decreases in new cervical cancer cases, which in turn is related to a reduction in the mortality rate for cervical cancer.
Data from Egyptian studies provide widely varying estimates on the prevalence of pre-invasive cervical lesions ranging from 1% to 8% with an age range from 20–60 years. Invasive lesions represented 59.58% of all female genital tract malignancy according to Egyptian National Cancer Institute data.
A recent monograph from the Egyptian National Cancer Registry of seven cancer centers of the Ministry of Health and Population, reported an incidence rate for all ages ranging from 0.12% to 0.77% depending on geographical regions, being more prevalent in Lower Egypt. To be stressed here, that most patients presented at late incurable clinical stages. Previous small hospital based series confirmed the incorporation of HPV genome in invasive lesions. In addition, schistosomiaisis, and Chlamydia trachomatis (Chlamydia T), has been found to be risk factors in Egyptian studies.
The main aim of the study was to determine the prevalence of CIN among married adult females in Minia Governorate, Egypt.
This was a prospective – population based – cross sectional analytic, survey study including married adult females in Minia Governorate, which was conducted on 1000 females; in the period from August 2019 – February 2020 at Al Minia cancer institute, Faculty of medicine – Minia University.
The main results of the study revealed:
• Age ranged from 23-62 years with mean value 41.47±8.919 years. The majority (94.1%) of our studied cases were married with a mean of duration 18.96±4.259 years. The most of their husband 73.2% were not traveling while 21.2% of husband was traveling and only 5.6% of husband was dead.
• Women parity ranged from 0-11 with mean value 4.14±1.826 with aa mean value of abortion 0.71±1.146. Number of living children was ranged between 0-9 with mean value 3.73±1.516 while dead children ranged between 0-6 with mean value 0.44±0.918. More than half of our studied cases had normal delivery while 147(14.7%) had CS delivery while 183(18.3%) had mixed (normal and CS).
• More than half of our studied had regular sexual frequency and only 2.3% of them had bleeding on intercourse. Time of last intercourse was ranged between 3 days -6 years with a mean value of 59.00±228.721 days.
• More than one third of our studied had regular menstrual frequency while 233(23.3%) had Amenorrhea and 223(23.3%) had menopause. LMB was ranged between 5 days -30 years with a mean value of 188.35±1048.338 days.
• Medical history of the studied group show that 92(9.20%) had HTN, 64(6.4%) had DM, 115(11.5%) had HCV and 3(0.30%) had HBV.
• 227(22.7%) using IUD, 220(22.0%) using Depoprovera, 110(11.0%) using Tubal ligation, 78(7.8%) using COCS, 9(0.9%) using Condom, 9(0.9%) using Implanon, 3(0.3%) using Coitus interruptus and 3(0.3%) using IUD and Depoprovera.
• Surgical History of the studied group show that 330(33%) had a history of CS, 120(12%) had a history of D&C, 27(2.7%) had a history of Malignant Thyroidectomy, 25(2.5%) had a history of Hysterectomy, 18(1.8%) had a history of Cervical Cautery, 16(1.6%) had a history of Myomectomy, 12(1.2%) had a history of Ovariectomy, 11(1.1%) had a history of Cystrectocele, 9(0.9%) had a history of Cerclage, 6(0.6%) had a history of Polypectomy, 6(0.6%) had a history of Ectopic pregnancy, 6(0.6%) had a history of Ovarian cystectomy, 3(0.3%) had a history of Cardiac Valve replacement, 3(0.3%) had a history of IVF, 3(0.3%) had a history of Appendectomy, 3(0.3%) had a history of Radiotherapy and 3(0.3%) had a history of Tubal ligation.
• 385(38.5%) complain from Offensive discharge, 272(27.20%) complain from Cheezy vaginal discharge and 3(0.3%) complain from Cystorectocele.
• 507(50.7%) were Normal, 130(13.0%) had Bleeding, 65(6.5%) had Profuse discharge, 54(5.4%) had Large cervix, 46(4.6%) had Cervical ectopy, 39(3.9%) had Cervical polyp, 38(3.8%) had Reddish cervix, 20(2.0%) had Nodular cervix, 15(1.5%) had Cervical follicles, 15(1.5%) had Blush cervix, 12(1.2%) had Hypertrophied, 9(0.9%) had Cervical erosion, 9(0.9%) had Cystorectocele, 7(0.7%) had Cervical edema, 7(0.7%) had Ulcer, 7(0.7%) had Closed cervix, 6(0.6%) had Transluscent discharge, 6(0.6%) had Irregular shape cervix, 3(0.3%) had Whitish Discharge, 3(0.3%) had Small cervix, 3(0.3%) had Cervical ectropion red cervix, 3(0.3%) had Opened eroded cervix, 3(0.3%) had Excessive creamy discharge, 3(0.3%) had Failed endocervical swap, 3(0.3%) had Fleshy red elongated cervix, 3(0.3%) had Forthy discharge, 3(0.3%) had Gilstening cervix, 3(0.3%) had Longitudinal vaginal septum, 3(0.3%) had Purple patches on cervix, 3(0.3%) had Refused examination and 3(0.3%) had Winkled cervix.
• Specimen adequacy of the studied group show that 170(17.0%) were missing, 774(77.4%) were satisfactory and 56(5.6%) unsatisfactory.
• Benign cellular (-ve cases) of the studied group show that 750(75.0%) had Inflammatory, 732(73.2%) had Mainly neutrophils and 113(11.3%) had infection.
• Epithelial cellular abnormalities (+ve cases) of the studied group show that 33(3.3%) had ASCUS, 12(1.2%) had LSIL and 3(0.3%) had Superficial squamous cells.
Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion.
Conclusion
In this study, the Prevalence of CIN among the studied women was 48 out of 1000 cases. With incidence of ASCUS was 33 out of 1000 cases and incidence of LSIL was 12 out of 1000 cases. Papanicolaou (Pap) smears can be used in national programs for cervical cancer screening. It is a suitable method for screening and an attractive alternative to cytology in low-resource countries.