Cervical cancer continues to be a substantial global public health concern. According to the GLOBOCAN 2020 estimates by the International Agency for Research on Cancer (IARC), cervical cancer accounts for approximately 604,000 new cases and 342,000 deaths annually [1]. In the Gulf Cooperation Council (GCC) countries, data from age-standardized incidence rates (ASIR) per 100,000 women show that Bahrain has a 2.7 ASIR of cervical cancer compared to 2.4 in the Kingdom of Saudi Arabia, 5.7 in the United Arab Emirates, and 6.4 in Oman [2].

A retrospective study conducted by Ismaeel, A. etal. in 2024 reviewed the medical records of 23,888 women who had a Pap smear test in Bahrain between 2019 and 2022, and found that Atypical Squamous Cells of Undetermined Significance (ASC-US) was diagnosed in 1.1% of cases. Thirty percent of these cases tested positive for high-risk HPV genotype, and 75% of them were infected with multiple genotypes [3]. In terms of histopathology results, 10.7% showed to be either CINii or CINiii, and a cytology follow-up within 1 year found that 8.4% of the cases progressed into either low or high-grade squamous intraepithelial lesions [3]. This underlines the importance of HPV co-testing and colposcopy in managing ASC-US.

Cytological screening using the Papanicolaou (Pap) smear and human papillomavirus (HPV) testing can provide an early detection, resulting in significant decreases in the disease’s incidence and mortality. However, Pap smear is not without limitations; its accuracy ranges between 50% and 80% in various studies using the same technique [4]-[6]. Similarly, the pap smear’s sensitivity and specificity in detecting CINii and CINiii have been shown to be between 45% and 98%, respectively [4]-[6].

The wide range of sensitivity and specificity is mainly due to sampling issues including inadequate tissue collection, and interpreter variability that involves cytologist experience, as well as collection techniques and patient factors like inflammation, infection, menopause and obesity.

Colposcopic examination, on the other hand, offers a more definitive diagnosis by providing visualization of the cervix and valvular tissue in addition to obtaining a biopsy of suspected lesions for histopathological examination [7]. Colposcopy has a high sensitivity for detecting cervical cancer, exceeding 90%, and when correlated with histopathology, the impression reaches 94.8% [8].

Despite established guidelines, the diagnostic performance of Pap smear combined with colposcopy varies by patient cohort, examiner experience, and histopathological rigor. Consequently, there remains a need for institution-specific validation of these screening tools to optimize triage, reduce false positives/negatives, and enhance early detection of cervical neoplasia.

Cervical cancer is one of the leading cancers among women, causing substantial morbidity and mortality rates. Cervical cancer can be prevented by early detection of cytological changes by using appropriate screening methods.

To evaluate the correlation between abnormal Pap smear cytology and colposcopy impressions, using histopathological findings as the gold standard, in women referred with abnormal cervical cytology in Bahrain.

The analysis included participants for whom at least 75% of the data was complete. After applying this criterion, 344 participants were retained for further analysis, while those with incomplete data were excluded. Majority of the biopsy was sampled from cervical biopsy (n = 169) followed by cervical polyps (n = 83) and uterus (n = 64). The mean age of the participants was 50.06 ± 12.95.

The inclusion criteria were women, with symptoms suggestive of abnormalities, who underwent colposcopy, who have all their data.

Women of all ages were included in this research, including premenopausal and post-menopausal females.

Ethical approval was obtained from ethical approval committee in King hamad university hospital.

Patients upon receiving treatment or investigation in King hamad university hospital they sign a consent for gathering information and using this information for research purposes.

Data was obtained from patient files upon their consent.

A table was constructed with the information needed and was filled using the information from patients’ files.

Cross-Tabulation Analysis as well as Bivariate Analysis were the analytic methods used in this study.

These methods collectively allow for a robust analysis of the relationships between demographic factors, health history, and clinical outcomes. They help in identifying significant associations that can inform clinical practice and public health initiatives.

StudyDesign

ObservationalStudy: The study appears to be observational, possibly cross-sectional, examining the relationships between

various demographic and health-related variables and clinical outcomes (e.g., abnormal colposcopy results).

DataCollection

DemographicandHealthData: Information on age, marital status, medical history (e.g., autoimmune diseases, malignancies, diabetes), and clinical outcomes (e.g., abnormal colposcopy, pap smears) was collected.ClinicalAssessments: Data on biopsy results, colposcopy findings, and other health indicators were gathered.

With respect to Viral Infection (Positive HPV testing, detected by pap smear in the clinic) and Abnormal Colposcopy (Findings other than normal, like ectropion, masses, acetowhite areas, redness of the cervix, friable tissues) (r = 0.140, p = 0.008) these were the results:

Abnormal pap smear refers to results other than negative for intraepithelial lesion or malignancy, so it includes ascus, LSIL, HSIL, cervical cancer.

There is a weak positive correlation between viral infections and abnormal colposcopy results. This suggests that patients with viral infections may have a slightly higher likelihood of abnormal findings during colposcopy. This could indicate that viral infections might play a role in cervical changes that warrant further investigation.

Patients that had no viral infection that were a total of 298, 108 of them (94.7%) had normal results; 190 (87.9%) had abnormal results.

Patients that had viral infection, 5.3 % had normal results, while 26 (12.0%) had abnormal results.

OR: 2.35 (95% CI: 0.93 - 5.92), p = 0.04 (statistically significant).

CorrelationResults

This study showed that there is a weak positive correlation of viral infection with abnormal colposcopy (r = 0.140, p = 0.008).

There is a weak negative correlation of age with abnormal colposcopy (r = −0.159, p < 0.001).

Between age and viral infection there is a negative correlation (r = −0.219, p < 0.001) (Table 1 and Table 2).

Table 1. Cross tabs.

Table 2. Correlations.

**. Correlation is significant at the 0.01 level (2-tailed).

The patients who had viral infection had a higher odd of developing abnormal colposcopy [OR 2.35 (95% CI 0.93 - 5.92), p = 0.04].Bivariate analysis: Abnormal colposcopy has a weak positive correlation with viral infection (r = 0.140, p = 0.008) and weak negative correlation with age (r = −0.159, p =< 0.001)

Having pap smear routinely improves outcomes and prognosis of cervical cancer as proved many published reports. Early detection by pap smear is always a good initial step in improving outcomes. Our study has proved that having abnormal pap smear results is correlated with having abnormal colposcopy findings.

The findings of this study underscore the critical interplay between abnormal Pap smear results, histopathological assessments, and colposcopic findings in the context of cervical cancer screening. Our results indicate a strong correlation between abnormal Pap smears and significant colposcopic findings, which aligns with existing literature suggesting that Pap smear abnormalities serve as a reliable indicator for further investigation through colposcopy.

The Pap smear test is a crucial and effective way to check for cervical cancer. Precancerous lesions are treated, and women are screened for the condition using Pap smears globally. In certain industrialized nations, Pap smear screening has shown impressive success in lowering cervical cancer mortality and incidence.

Significant associations were found between abnormal colposcopy results and factors such as autoimmune disease, malignancy, diabetes, and viral infection.

There is a weak positive correlation between viral infection and abnormal colposcopy, and a weak negative correlation between age and abnormal colposcopy.

These results suggest that certain demographic and health-related factors are associated with the likelihood of abnormal findings during colposcopy, which could inform targeted screening and prevention strategies.

In conclusion, our study highlights the importance of a multidisciplinary approach in cervical cancer screening, advocating for the combined assessment of Pap smear results and histopathological findings to optimize colposcopic evaluations. By enhancing the understanding of these relationships, we can improve patient care and outcomes in the prevention and management of cervical cancer.