Comparative Performance of Pap Smear and Colposcopy in Cervical Cancer Screening Among Women With Abnormal Cervical Findings in Central India: A Prospective Observational Study.

Background: Cervical cancer remains a leading cause of death among women worldwide, particularly in low- and middle-income countries. This study aimed to evaluate and compare the effectiveness of Pap smear and colposcopy in detecting cervical abnormalities in women with unhealthy cervices and correlate findings with biopsy results. Methods: A prospective observational comparative study was conducted from July 2018 to December 2020. Women with abnormal cervical appearances or symptoms were enrolled. Each participant underwent a Pap smear followed by colposcopy, and cervical punch biopsies were performed on those with abnormal findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for both methods, using biopsy results as the gold standard. Results: Of the 82 participants, 74% were from rural areas, and the majority belonged to the lower-middle socioeconomic class. Pap smear had a sensitivity of 77.14%, specificity of 63.64%, PPV of 87.1%, and NPV of 46.67%. Colposcopy showed a higher sensitivity of 90.91% but lower specificity of 37.5%, with a PPV of 85.71%. Diagnostic accuracy was 73.91% for Pap smear and 80.49% for colposcopy. Both methods were significantly associated with biopsy-confirmed findings of cervical intraepithelial neoplasia (CIN) and invasive cancer. Conclusion: Pap smear and colposcopy are valuable screening tools, but their limitations underscore the need for supplemental diagnostic methods like biopsy, particularly in cases with abnormal findings. In low-resource settings, innovative strategies such as "screen-and-treat" approaches should be considered to overcome barriers like follow-up challenges and false-negative rates, improving cervical cancer detection and prevention.