Research Article

Knowledge Gaps, Reproductive History, and Cytopathological Outcomes inWomen Undergoing Cervical Cancer Screening: A Cross-Sectional Study from Southern Iraq

Abstract

Objective: To assess the burden and factors associated with abnormal cervical cytology in women attending an outpatient clinic for gynecology in the southern region of Iraq, and to identify Pap smear awareness, education, and contraceptive and symptom-based triage signs. Methods: The current study was a cross-sectional study carried out at Al Imam Al Sadiq Teaching Hospital, Babylon Governorate, from December 2022 to December 2024. Consecutive female patients (age ≥ 18 years) with any gynecologic complaints were selected, and pregnant women, patients with known cervical cancer, and those with inadequate/unsatisfactory smears were excluded. Data were collected using a structured interviewer-administered questionnaire that included questions on sociodemographic, reproductive, behavioral, awareness, and clinical characteristics. Conventional Pap smears were collected and reported in accordance with the Bethesda System of 2014 and dichotomized as normal/reactive (NILM + cervicitis) or abnormal (ASCUS, LSIL, HSIL, AGIN, SCC). Group comparisons were made using the Mann–Whitney U, chi-square, or Fisher’s exact tests. Univariable and multivariable logistic regression analyses were used to identify independent predictors of abnormal cytology, and receiver operating characteristic (ROC) analysis was used to evaluate the discrimination of the models. Results: A total of 234 (83.3%) women of the 270 enrolled had interpretable cytology, 20.9% (48) of whom had abnormal cytology results. Bleeding on touch, postcoital bleeding, smoking, and a history of genital warts were independently associated with abnormal cytology; however, after adjustment, the association between IUD use and age ≥ 40 years was not significant. The three-category outcomes (NILM, cervicitis, and abnormal) presented clearly defined age and symptom distributions for inflammatory and epithelial lesions. Awareness of Pap smear was very low, but women who reported awareness had higher rates of abnormalities (referral bias). The multivariable model had good discrimination (AUC ≈ 0.80), and at the optimal threshold (Youden), had a very high specificity, making it useful as a rule in triage in low-resource clinics. Conclusion: Bleeding related signs, certain behavioral risks, and age were significant factors, and abnormal cervical cytology was prevalent in this symptomatic Iraqi population. The use of awareness, education, and structured speculum findings in multivariable risk stratification provides a new, pragmatic approach to cervical cancer control in resource-limited environments. 

Authors affiliation:

Hadeel Abdulameer Shamkhi Alshlah (ORCID): Department of Gynecology and Obstetrics, College of Medicine, University of Al-Ameed, Karbala, Iraq

How to Cite: H.A.S. Alshlah. Knowledge Gaps, Reproductive History, and Cytopathological Outcomes in Women Undergoing Cervical Cancer Screening: A Cross-Sectional Study from Southern Iraq. Healthcare Studies, 4(1):115–125, 2026. https://doi.org/10.58612/hs4115