European Journal of Cardiovascular Medicine

Cancer is a non-communicable disease which accounts for 12-15% of the total deaths worldwide and is the third major cause of mortality being next to cardiovascular diseases that involves abnormal cell growth with the potential to metastasize to other parts of the body.^1,2Cervical carcinoma can be diagnosed at an early stage with screening since cervical intraepithelial neoplasia has a long latency period.³ Change in lifestyle, urbanisation, industrialization, and modernization have been blamed to be leading to genomic instabilities, resulting in infertility, congenital malformations, and malignancies and have shown a paradigm shift in the disease.⁴The nuclear anomalies suggestive of genotoxicity include budding, binucleation, micronucleation, broken eggs, karyorrhexis, and karyolysis.⁵ It also can be seen either as chromosomal breakage or chromatid fragments or a whole chromosome that could not get incorporated into the daughter cell during mitosis.

There are several risk factors for cervical cancer that are related to HPV exposure. The development of invasive cancer may take up to 20 years after the initial HPV-related precursor lesion.⁷ But there are also a lot of additional risk factors (including sexual and reproductive factors, behavioural factors, etc.) for cervical cancers, like having multiple sexual partners when you're young (less than 16), smoking, having high parity, and having a low socioeconomic status.^8,9 About 11.4% of women in the general population are estimated to be infected with the Human Papilloma Virus (HPV) at any given time. Approximately 70–90% of invasive cervical cancer cases globally are linked to HPV16 and HPV18.¹⁰ The MN test is a reliable and popular method for assessing chromosomal abnormalities brought on by exposure to substances that can cause cancer or mutagenesis.¹¹In the present study an attempt was made for the early diagnosis of cervical carcinoma at an early stage in order to improve the prognosis and provide the patient a better quality of life.

A prospective study was conducted among 500 females attending colposcopic clinic were studied for micronucleus and nuclear abnormalities in Department of Anatomy of World Medical College, Jhajjar. A standard Proforma was prepared and a proper recording of detailed menstrual, obstetrics, gynaecological and personal history was recorded. From all these casescervical smear and urine samples were collected and examined for micronucleus and other nuclear abnormalities. The data thus collected was analysed using appropriate statistical tests.

Parameters:

1. MN- Micro nucleated cells
2. BN - Binucleated cells
3. KR- Karyorrhexis
4. KL- Karyolysis
5. Budding

Table 1. Distribution of the study group according to age group

Table 2. Distribution of the study group according to age group and Karyorrhexis

χ² value= 10.863                df=15                                 p value, Sig=0.762, NS

Table3. Distribution of the study group according to age group and Karyolysis

χ² value= 7.512                  df=10                                 p value, Sig=0.676, NS

Arrow showing nuclear variations in binucleated (BN) cell undergoing Karyorrhexis (x 40X)

Arrow showing nuclear variations in Cells undergoing Karyorrhexis (KR) (x 100X)

Cell showing Karyolysis (KL) in cervical smear (x 100X)

Risk factors and age group:

The age group was not significantly associated with any of the risk factors in this study. Early menarche was the main risk factor in cases of less than 20 years old, post coital bleeding in 21 – 30 years age group, age at menarche more than 18 years in 31 – 40 years age group, LBA in cases of 41 – 50 years age group, post coital bleeding in 51 – 60 years age group and leucorrhea in more than 60 years of age group were the main risk factors. There has been evidence that younger women who engage in sexual activity have an increased chance of developing cervical cancer.

Age group and Karryorhexis:

About 23.2% of the cases with no Karyorhexis were aged between 51 – 60 years, with 1 – 3 Karyorhexis were aged between 21 – 30 years and 41 – 50 years, 3 – 6 Karyorhexis were aged between 21 – 30 years, 31 – 40 years and more than 60 years and more than 6 Karyorhexis were aged between 31 – 40 years. This difference in number of Karyorhexis was not statistically significant with the age group.¹²

Age group and Karyolysis:

About 23.2% of the cases with no Karyolysis were aged between 51 – 60 years, with 1 – 5 Karyolysis were aged between 21 – 30 years and more than 5 – 9 Karyolysis were aged between 31 – 40 years. This difference in number of Karyolysis was not statistically significant with the age group.¹³

This study had shown that, frequencies of binucleate nucleus were higher in cases aged between 21 – 30 years. Karyorhexis and Karyolysis was higher in cases aged between 31 – 40 years.

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