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  • Title: Cellular composition of cervical smears in relation to the day of the menstrual cycle and the method of contraception.
    Author: Vooijs GP, van der Graaf Y, Elias AG.
    Journal: Acta Cytol; 1987; 31(4):417-26. PubMed ID: 3604536.
    Abstract:
    The influence of the day of the menstrual cycle and the method of contraception on the cellular composition of cervical smears was investigated. The percentage of unsatisfactory smears during the first four days of the cycle was understandably very high, leaving only 80% of the smears of sufficient quality for cytologic diagnosis. The percentage of smears of insufficient quality during the remainder of the cycle was significantly higher in women using oral hormonal contraceptives. The percentages of smears containing endocervical columnar cells, a criterion for judging smears to be of high quality, differed significantly among women using different modes of contraception. The highest percentage of smears without endocervical columnar cells was found in women using oral contraceptives; during the first half of the cycle in these women, smears were of higher quality than during the second half of the cycle. In women not practicing contraception or using nonhormonal methods of contraception, the differences in cellular composition during the cycle, though significant, were too small to be of practical importance. Women using oral contraceptives thus have an increased risk for a potential false-negative diagnosis because of the higher percentage of smears of unreliable quality taken in these women. In women using oral hormonal contraceptives, smears should be taken during the first half of the cycle because of the higher percentage of smears of high quality in that period. Data were derived from a population-based screening program for cervical cancer, in progress in the region of the city of Nijmegen, the Netherlands, since 1976, to investigate the influence of the day of menstrual cycle and method of contraception on the cellular composition of cervical smears. The study covers an 8-year period. Women 35 through 54 years of age were screened once 3 years. A single cervical smear was taken with a slightly modified, pointed, wooden Ayre spatula. The smears were processed at the cytology laboratory of the Department of Pathology, University of Nijmegen and screened by experienced cytotechnologists. The cytologic findings were recorded by means of a revised Papanicolaou classification. For the purposes of this study, the cellular composition of the smears was considered in relation to the day of the menstrual cycle on which the smear was taken. To evaluate the relation between the cellular composition of smear and the day of the menstrual cycle, the smears were subdivided into 3 groups: smears unsatisfactory for cytologic diagnosis; smears with endocervical columnar cells present; and smears without endocervical columnar cells. The menstrual cycle was divided into 11 periods. The women participating in the study were subdivided 4 groups according to the mode of contraception practiced: women not practicing contraception; women using oral contraceptives (OCs); women using an IUD and women using other (surgical or mechanical) methods of contraception. During 8 years of screening, 152,379 women were entered in the screening program. From this group, 117,211 women were selected in whom the cervix was visible when the smear was taken and who indicated having regular menstrual periods. The cellular composition of cervical smears correlated significantly with the day of the menstrual cycle and the contraceptive method used. The numbers of smears unsatisfactory for cytologic diagnosis was significantly higher in smears taken during the first 4 days of the menstrual cycle; only 80% of the smears made during these days were of sufficient quality for cytologic evaluation. When days 0-3 were excluded from the analysis, the number of unsatisfactory smears taken from days 4 through 6 was significantly higher than in any other period of the menstrual cycle. This was the case in all 4 subgroups of contraception, but it was particularly evident in IUD users. The average percentage of unsatisfactory smears for the remainder of the men menstrual cycle differed significantly between women using different contraceptive methods. The percentage of unsatisfactory smears was highest in women using OCs.
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