Modelling risk assessment for cervical cancer in symptomatic Saudi women

OBJECTIVES: To assess whether the utility of cervical cancer screening could be improved by combining multiple factors in addition to the pap test. METHODS: A retrospective cohort study of 300 symptomatic women who were suspected to have cervical cancer and referred for biopsy examination at King Abdulaziz Medical City, Riyadh, Saudi Arabia between February 2017 and December 2017. RESULTS: A high risk of cervical cancer in Saudi women was associated with 4 risk factors: family history (adjusted odds ratio [aOR], 4.216; 95% confidence intervals [CI], 1.433–12.400), vaginal bleeding (aOR, 3.959; 95% CI, 1.272–12.318), hypertension (aOR, 4.554; 95% CI, 1.606–12.912), and an abnormal pap smear test (aOR, 13.985; 95% CI, 5.108–38.284). The model yields an adequate utility (area under the curve, 87.5%, 95% CI, 80.9-94.0%) with acceptable goodness-of-fit (p=0.6915). CONCLUSION: The pap smear test alone is inadequate to assess high risk for cervical cancer in our center. Early detection of cervical cancer may require consideration of a combination of factors including the pap test. This study has shown that using a combination of abnormal family history, vaginal bleeding, hypertension, and the pap smear test improved the effectiveness of cervical cancer screening.