Objective: To Determine the Accuracy of Pap smear & Colposcopy Screenings in the early detection of pre invasive disease and cervical cancer at a tertiary Gynaeoncology Center in Malaysia.

Pap smear has been the gold standard for cervical cancer screening for the past few decades. Colposcopy has been used as an adjunct in diagnosing pre invasive cervical disease and cervical cancer. This was a retrospective observational study done on patients attending the colposcopy clinic in the Department of Obstetrics & Gynecology, Hospital Sultan Ismail Johor Bahru, a tertiary gynaeoncological referral hospital. The study evaluated all abnormal Pap test referred for colposcopy from 2014 to 2016.

Methods & Results: The study was done on 163 women who came with an abnormal Pap smear or abnormal looking cervix or symptoms. We looked at several key points such as the incidence & demographics of patients with abnormal smears referred for colposcopy, the indications of referral for abnormal Pap smears, the correlation between the Pap smear & colposcopy results, the correlation between colposcopy finding and histology results & finally the incidence of cervical cancer detected by Pap smear and colposcopy.  The commonest age group referred for colposcopy was between the ages 40 to 60 years old. The majority of the patients (32 %) who were referred for colposcopy had HSIL. The percentage of Pap smear-colposcopy correlation over the 3 years was averaging 50 % to 65 % which is roughly the sensitivity of the Pap test. The rate of correlation between colposcopy and final histopathology improved with each year as the training of doctors improved. In 2014, 59 % of the patient’s colposcopy results correlated with the biopsy, while in 2016, 68% of the data correlated. This is fairly similar to other centers which have recorded correlation rates of 60 – 70 %.

Conclusion: Cervical cancer is a preventable disorder as there are effective screening and diagnostic tools. A Pap smear can detect abnormal cells in the cervix while colposcopy helps in detecting the lesions on the cervix with better precision and helps confirm the diagnosis. From our study, we also found that colposcopy performs better in detecting high grade lesions than low grade lesions. Our study also showed that multiple colposcopic guided biopsies are more specific and accurate than single biopsy alone. As doctors training improved, the rate of correlation and positive predictive value also increased.