The incidence of HIgh Grade Lesions ( HSIL) on cervical smears from women under 30 years in Cape Town, South Africa is recorded. Women in SA are only offered a free cervical smear at age 30 and then every ten years until age 50.. The clinical, public health, and psycho social implications of this issue are discussed.

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)
Sharon Fenwick CTIAC
Dr Despina Learmonth, D Psych*
Nicholas Low, Medical Student
Yvonne Parfitt Cancer Research Cytology Laboratory,
NHLS Groote Schuur Hospital, and
*Department of 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 3 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 South Africa
Age of sexual debut amongst women in SA is 16.9 yrs.
They are at risk for sexually transmitted infections
including Human Papilloma Virus and HIV.
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 2009 to
2011 inclusive:
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 2009-2010: 108,542
Total Women under 30yrs: 23,317 (21%)
Total Women ref. to Colposcopy: 3,080
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. Results
Total smears in
2009-2010
108,542
Total under 30 yrs
23,317
Total over 30 yrs
85,225

8. Women referred for Colposcopy
Total referred
to Colposcopy:
3,080
Total under
age 30yrs:
577

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 the radiotherapy, results 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.