Causes of Low Sensitivity of Papsmear Tests in Hamadan

Papsmear test has been performed by public health services since 1991 in Iran. Although cervix cancer is reported 9th cause of death in four studied counrties in 1999, unfortunately detection rate of smear test is reported very low. The aim of this study was to determine the cause of low sensitivity of Papsmear in Hamadan province- north west of Iran. 1224 smears randomly selected from total smears and were evaluated by cytologist in 2000. All smears were reevaluated with pathologist to find out valid answers to these questions; do smears prepared appropriately, and do smears evaluated correctly? Collected data was analyzed using descriptive statistics. Problems classified in 3 stages. Sampling stage (11.7%); included; 43.7% loss of endocervical cell, 34.7% low cell density, 28.8% over coverage with inflammatory cell and 4.2% poor fixation in sampling stage. Preparation stage (74.5%); included coloring and sticking lamella to lame. 47.5% of prepared smears were not valuable, 30.1% contained unfavorable stick, 14.2% with wrong coloring, 2.7% related to putting the lamella over lame. Evaluation stage; there was 96/6% agreement between cytologist and pathologist in this case after excluding inappropriate smears from evaluation.. The study demonstrated that the most important problem in low sensitivity of Papsmears was related to preparation stage rather than the sampling and evaluation stages. Lower sensitivity of Papsmear test in Iran than other countries (11/7% versus 70%) may put women at high risk of developing cervix cancer. Training public health staffs and monitoring Pap smear test in Iran is highly recommended.