Cervical cytomorphologic presentations: association with pre-cervical cancer determinants in women from Nakuru county
Wanjiku, Muitta Esther
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Cervical cancer disease is among leading global cancers in women and it causes reproductive tract ill health. The disease is preceded by pre cancer status identified by detection of abnormal cells in smears from the cervical wall. High risk genotype16 and 18 human papilloma virus is implicated. Other predisposing determinants include Chlamydia trachomatis infections, lifestyle and nutritional factors for example healthy diet inadequacies, and chronic reproductive tract ill health. The link between these determinants and pre cervical cancer grades has only partially been examined with no studies reported among women from Nakuru County. This descriptive cross-sectional study was conducted at Nakuru County referral hospital to examine the relationship of determined pre cervical cancer grades in regards to cervical epithelial cytomorphologic features with outcomes of select microbial STI, lifestyle and reproductive health characteristics among women participants. A total of 142 women participants, ≥ 20years of age, were purposively enrolled into the study. Manifested clinical signs, lifestyle and diet practices were collected using a questionnaire. Anthropometric physical measurements were recorded. Serum extracted from whole blood was screened for Treponema pallidum and HIV antibodies. In addition endocervical swabs were used for Neisseria gonorrhea, Chlamydia trachomatis antigen and HPV oncoprotein detection while endocervical scrape smears were examined for cyto-morphological profiling and categorization of enrolled subjects using the Bethesda 2014 classification into four pre cervical cancer study groups of: 1) LSIL; n=35; 2) HSIL; n=59; 3) AGC/AIS; n=8 and 4) controls; (No evidence of cellular lesion) n=40.Cytomorphologic findings indicated that in all participants,~67% subjects manifested koilocytic cells, while ~28% had high grade cellular atypia in their smears. Select STI screened indicated that ≥11% subjects were positive for HIV1/2 and at least 10% for HR HPV 16/18. Collectively at least ~6% of test subjects tested positively for Treponema pallidum, Neisseria gonorrhoea and Chlamydia trachomatis. Additionally, multivariate logistic modeling indicated that HPV16/18 was associated with likelihood of having LSIL, HSIL and AGC/AIS pre cancer grade (P<0.0001; β>3.600; OR>2.0; 95% CI). Lifestyle and nutritional assessment illustrated that anthropometric median values ≤99 cm for bust girth and ≤86cm for waist circumference were associated with higher risks of presenting with HSIL and AGC/AIS grades (P<0.04; β>1.681; OR>5.0; 95% CI), while history of consuming unhealthy diet was associated with higher odds of presenting with LSIL (P=0.012; β, -1.433; OR; 4.190; 95% CI;). Reproductive health evaluation revealed that history of lower abdominal pain and vaginal bleeding was associated with higher chance of presenting with LSIL (P=0.003; β=1.758; OR=5.800; 95% CI); HSIL (P=0.001; β=2.183; OR=8.873; 95% CI) or AGC/AIS (P<0.0001; β=25.347; OR=1.019; 95% CI). These results confirm that a high koilocytic atypia magnitude in examined smears is a true pointer of pre cervical cancer genesis. Moreover, HR HPV16/18 infection, upper trunk and abdominal wasting gauged from low median scopes of bust and waist, consumption of unhealthy diet and clinical history of protracted symptomatic manifestation of abdominal pain and vaginal bleeding are important predictors of the development of pre cervical cancer in women from Nakuru County. Therefore, maximum atypia detection should further be enhanced through employment of LBC. Screening of HR HPV infections, integration of anthropometric measure, adopting nutritional counseling and reproductive tract sign monitoring and care in the MCH would reduce risk of developing pre cervical cancer signs.