Biomoleculer Screening on Women\Risked Servical Cancers in

Medan North Sumatera

Fatwa Imelda

, Nurbaiti

Faculty of Nursing, Universitas Sumatera Utara, Medan, Indonesia

Keywords : Servical cancers, Pap smears, Immunohistochemistry

Abstract: Cervical cancer is a women's health problem in Indonesia with the first order with high mortality. Effective

screening that can be used is Papanicolau Tests (Papsmears) to detect precancerous lesions and

immunohistochemistry techniques to identify the image of cervical cancer gene triggers in women at risk of

cervical cancer.This study aims to see biomolecular screening on women risked cervical cancers in Medan

North Sumatera.This study used cross sectional design. Samples were taken by consecutive sampling

technique. The number of samples taken as many as 80 samples, divided into 2 groups of 40 samples were

examined papsmears and 40 samples were examined immunohistochemistry technique.Pap smears from risk

factors such as 72.5% of respondents were age group more than 35 years and 37.5% the results of papsmears

not normal, 97.5%married respondents with abnormal 47.8% papsmears results, 67.5% were unemployed

with abnormal 35% pap smears results, 62.5% of respondents with regular women's menstrual cycles with an

abnormal 30% papsmears, 75% of respondents with a history of not using contraception with a majority of

abnormal papsmears of 37.5%. immunohistochemistry technique from risk factors such as age of over 35

years had IHC +1 (7.5%) and IHC +3 (2.5%), married status (87.5%) with HC +1 (7.5%) and IHC +1 (2.5%)

result IHC +1 have high school education (5%), Diploma (2.5%) and IHC +3 (2.5%), with status not working

with IHC +1 (5%), and IHC +3 (2.5%), history parity has the same distribution of ≤ 2 and 2 with 45% sample

with female parity status with IHC intensity 0 and parity ≤ 2 with IHC intensity +1 (2.5%) and IHC intensity

+3 (2.5%), with regular menstrual cycle with IHC +1 result (5%), and irregular menstrual cycle with IHC +3

(2.5%), non-FP (30%) result, with FP Mantap of IHC +1 (5%) and FP Hormonal with IHC +3 (2.5%).

1 INTRODUCTION

Cervical cancer in developed countries ranks fourth

after breast cancer, colorectal and endometrium,

while in developing countries ranks first (Kemenkes

RI, 2015). Various risk factors have been identified to

increase the risk of cervical cancer, namely; sexual

intercourse, patner characteristics, gynecological

history, diethylstilbesterol (DES), infectious agents,

Human Papilloma Virus (HPV), Herpes Simplex

Virus, smoking. Some other predicted risk factors

increase the risk of cervical cancer, namely: oral

contraceptives, diet, ethnic and social and

occupational factors (Imam, 2009). Human

Papilloma virus as the cause of cervical cancer is

found in 99.7% of cases of cervical cancer. It is the

WHO reason to set HPV 16 and 18 to be a carcinogen

agent in humans.

Cancer cells are the accumulation of a number

of genetic changes that contribute to the incidence of

tumorigenesis, tumor progression and resistance to

chemotherapy. Most of these genetic changes result

in cell cycle regulation. Loss of some molecular

checkpoints, found in the development of some

tumors, is because of cell cycle progression that

becomes dysregulated. The accumulation of genetic

changes contributes to the onset of chemoresistance

resulting in the ability of DNA to respond to damage.

Detectable DNA damage is regulated by a 53 p

Suppressor tumor, when the DNA damage is severe

enough p53 to initiate a cell death program

(apoptosis) (Calvagna, 2007).

534

Imelda, F. and Nurbaiti, .

Biomoleculer Screening on WomenServical Cancers in Medan North Sumatera.

DOI: 10.5220/0010077405340541

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

534-541

ISBN: 978-989-758-449-7

2 METHOD

This study used a cross sectional research design with

research design by measuring or observing research

subjects simultaneously or once. The population of

this study women at risk of cervical cancers. The

sample was taken by consecutive sampling technique

that is the sample selection by setting the subject

according to the inclusion criteria in the research until

the sample quantity is fulfilled. The research was

conducted at Bhayangkara Hospital Medan, the

location of this study was taken because the general

hospital in the city of Medan and have women at high

risk of cervical cancer both in terms of age, hormone

contraceptive use. The study duration is one year.The

number of samples taken as many as 80 samples,

divided into 2 groups of 40 samples were examined

papsmear and 40 samples were examined

Immunohistochemical technique.

After getting permission from the hospital, the

researcher collected the data. The first stage of data

collection of prospective respondents are classified

as: married and sexually active women,

gynecological history of more than two children, use

of diethylstilbesterol (DES), smokers or passive

smokers, body weight, use of oral

contraceptives.Then the cotton biopsy sample was

taken for pap smear and IHC examination. After the

data of all actions done finished then continued by

comparing the data of pap smear and IHC

examination results.

The Research Ethics Committee from the

Commission of Health Research Ethics Faculty of

Nursing University of Sumatera Utara No.

1154/IV/SP/2017. The data was analyzed using

univariat so that just gotten the frequency

distributions.

3 RESULT

Table 1 shows that most (72.5%) of the samples are

age group over 35 year old and the majority of normal

and abnormal papsmears at age >35 year old is

37.5%. Table 2 shows that most (70%) of the samples

are age group over 35 year old having negative

intensity 0 (negative p53) and 7.5% intensity +1 (p53

negative) and 2.5% intensity +3 (P53 positive or

protein expression p 53 over expression). Table 3

shows that most (97.5%) of samples with marital

status married with a majority result of abnormal pap

smear 47.5%. Table 4 shows that most of the samples

with married marriage status (87.5%) with the

majority of IHC results with intenistas 0 (negative

P53) and 7.5% IHC +1 results (negative p53) and

2.5% with IHC +3 results (P53 positive or protein

expression p 53 over expression). Table 5 shows that

most (50%) women with senior high school education

degree with a majority of pap smear are abnormal at

25%. Table 6 shows that most of the samples (90%)

with IHC results of intensity 0 (negative P53) have

senior high school (42.5%), Diploma (15%),

Bachelor (32.5%) and IHC results of intensity +1

(negative p53) (5%), Diploma (2.5%) and IHC +3

results (positive p53 / over p53 expression) of (2.5%).

Table 7 shows that most (67.5%) with status not

working with abnormal Paps Smear results of 35%.

Table 1. Frequency distribution by age of women with Pap Smear

age

(years)

frequency

sample

percentage

sample

frequency

abnormal

pap

smear

percentage

normal

pap smear

frequency

abnormal

pap

smear

percentage

abnormal

pap smear

<20

20-35

12.5

>35

37.5

Biomoleculer Screening on WomenServical Cancers in Medan North Sumatera

535

Table 2. Frequency distribution by age of woman with IHC

IHC

results

<20

years

sample

20-

years

sample

>35

years

sample

total

sample

20 %

70%

90%

7.5%

2.5%

Table 3. Frequency distribution by marriage status of women with PapSmear results

marital

status

freque

ncy

sample

percent

age

sample

frequency

abnormal

pap smear

percentage

normal pap

smear

frequency

abnormal

pap smear

percentage

abnormal

pap smear

Married

97.5

47.5

divorced/

widowed

2.5

Table 4. Frequency distribution by marriage status of women with IHC results

IHC

result

merried

sample

Divorced/

widow

sample

total

sample

87.5%

2.5 %

90%

7.5%

2.5%

Table 5. Frequency distribution by marriage status of women with IHC results

educational

degree

frequency

sample

percentage

sample

frequency

abnormal pap

smear

percent

age

normal

pap

smear

frequency

abnormal

pap

smear

percentage

abnormal

pap smear

senior high

school

diploma

17.5

12.5

bachelor

32.5

12.5

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

536

Table 6. Frequency distribution by status of education of women of reproductive age with IHC results

IHC

results

senior

high

school

sample

diploma

sampl

bachelor

percentage

sample

total

total %

sample

42.5 %

15%

32.5%

90%

2.5%

7.5%

2.5%

Table 7. Frequency distribution based on women employment status with Pap Smear results

employment

status

frequency

sample

percentage

sample

frequency

abnormal

pap smear

percentage

normal pap

smear

frequency

abnormal

pap smear

percentage

abnormal pap

smear

working

22.5

17.5

not working

67.5

32.5

Table 8. Frequency distribution based on women employment status with IHC results

IHC

results

labor

sample

not

working

sample

total

total %

sample

30%

60%

90 %

2.5 %

5 %

7.5 %

0 %

2.5 %

Table 9. Frequency distribution by women Parity with Papsmear results

Parities

history

frequency

sample

percentage

sample

frequency

abnormal

pap smear

percentage

normal pap

smear

frequency

abnormal

pap smear

percentage

abnormal pap

smear

≤ 2

17.5

32.5

17.5

Biomoleculer Screening on WomenServical Cancers in Medan North Sumatera

537

Table 10. Frequency distribution by women parity with IHC results

IHC

results

≤

sample

total

precentage

sample

45 %

90%

2.5%

7.5%

2.5%

Table 11. Frequency distribution based on women menstrual cycle with Papsmear result

menstrual cycle

frequency

sample

percentage

sample

frequency

abnormal

pap smear

percentage

normal

pap smear

frequency

abnormal

pap smear

percentage

abnormal

pap smear

regularr

62.5

32.5

irregular

12.5

17.5

not menstruation

7.5

2.5

Table 12. Frequency distribution based on women menstrual cycle with IHC results

IHC

results

regular

sample

irregular

sample

not

menstruation

sample

total

sample

60 %

22.5 %

7.5%

90%

2.5 %

5 %

7.5%

0 %

2.5 %

7.5%

Table 13. Frequency distribution based on women menstrual cycle with IHC results

FP history

frequency

sample

percentage

sample

frequency

abnormal

pap smear

percentage

normal pap

smear

frequency

abnormal

pap smear

percentage

abnormal pap

smear

hormonal FP

12.5

7.5

Simple FP

IUD

7.5

2.5

mantap FP

2.5

not using FP

37.5

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

538

Table 14. Frequency distribution based on FP history with IHC results

IHC

results

Hormo

nal FP

sample

IUD

sample

mantap

sample

not using

sample

total

% total

sampel

0 %

2.5%

0 %

2.5%

Table 8 shows that most samples (60%) with

status not working with IHC intensity 0 (negative

p53) and 5% with IHC intensity +1 (negative p53) of

5%, and IHC +3 results (positive P53) of 2.5%. Table

9 shows that the history of parity has the same

distribution of ≤ 2 and> 2 with 50% of the sample

with the parity status of women with an abnormal

number of papsmear of 32.5 in the history of parity ≤

2. Table 10 shows that the parity history has the same

distribution of ≤ 2 and >2 with 45% of the sample

with female parity status with IHC intensity 0

(negative p53) and parity ≤ 2 with IHC intensity +1

(negative p53) of 2.5% and IHC result +3 intensity of

2.5%. Table 11 shows that most (62.5%) of samples

with regular women's menstrual cycles with an

abnormal number of pap smear are 30%. Table 12.

demonstrated that most (60%) samples with regular

menstrual cycles with IHC intensity 0 (negative

protein p53), and 2.5% samples with regular

menstrual cycles with IHC +1 (negative p53), and 5%

samples with irregular menstrual cycles with IHC +1

results (negative p53), and 2.5% of samples with

irregular menstrual cycles with IHC +2 results

(negative p53). Table 13 shows that most (75%)

respondents with not FP history with a majority of

paps mear are abnormal on 37.5%. Table 14 shows

that most of the samples are not using FP (30%) with

a result of IHC intensity of 0 (negative p53) and a

sample with the mantap FP of 5% with IHC +1

(negative p53), and a Hormonal FP sample with IHC

+3 result of (2.5%).

4 DISCUSSION

In the results of this study found that the majority of

samples> 35 years. In adult women over 35 years old,

the condition of the reproductive organs begins to

aging, and in theory it is explained that the risk factors

that can increase the incidence of women with

cervical cancer are premenarche and post menopause

(Baradero & Dayrit, 1998). Generally new mucosal cells

mature after women aged 20 years and over. When a

woman has sex at adolescence, It is the most

vulnerable done under the age of 16 years.

This is related to maturation of mucosal cells in

the cervix. At a young age mucosal cells in the cervix

are not yet mature and that means are still susceptible

to stimulation, so they are not ready to receive

stimulation from the outside, including chemical

substances that brought sperm. Because it is still

susceptible, mucosal cells can change the nature of

cancer. But when sex is done after the age of 20 years

in which mucosal cells are no longer too susceptible

to changes. HPV infection is influenced by age factor

and immune condition, both of these factors affect

false positive values. False positive values are

positive HPV DNA testing but after other tests such

as colposcopy, IVA and papsmear, no cervical cancer

is found. women over 30 years of age are more likely

to have an exact or persistent HPV infection (Novel,

Safitri, & Nuswantara, 2009).

The results of this study was the majority of

samples married status. This is in accordance with the

theory that married women increase the risk of

cervical cancer due to sexual behavior. Cervical

cancer can occur because of sexual activity, because

at the time of sexual intercourse the woman can enter

the female reproductive organs that can cause

infections that if not treated immediately can become

cervical cancer after several years later (Lisnawati,

2013).

Women who are sexually active at the age of 20-

35 years and infected by HPV will suffer from

cervical cancer in the 10-20 year period and married

women before the age of 20 years will be at risk of

cervical cancer because at that age the reproductive

organs are not ready to have sexual intercourse at

early age (Smeltzer & Bare 2002), but women who

Biomoleculer Screening on WomenServical Cancers in Medan North Sumatera

539

are slow to marry are also risk factors for cervical

cancer because these women will continue to ovulate

without interruption so that stimulation of the

endometrium occurs continuously so that it can make

endometrial cells change the nature into cancer cells.

The results of this study obtained the majority

with the results of papsmear and abnormal IHC at

most with the level of senior secondary education.

Acceptance of new behavior will be easier if based on

the correct knowledge, awareness and positive

attitude (Notoatmodjo & Soekidjo, 2012). Increased

knowledge will not always cause behavioral changes,

Lack of knowledge that causes poor perineal behavior

of hygiene can have an impact on the increasing

incidence of cervical cancer. Lack of knowledge in

maintaining vaginal hygiene and correct attitude

about maintaining cleanliness and lack of information

leads to a lack of new knowledge gained so that the

behavior of vaginal hygiene becomes dependent on

the environment (Nurhayati & Annisa, 2013).

The results of this study were obtained mostly

with the status of not working.Factory income related

to nutrition and immunity. Low income groups

generally have less quantity and quality of food and

this affects the body immunity. The strong

relationship between the incidence of cervical cancer

with low socioeconomic level. Low-income groups

are usually less accessible with quality health services

including pap smear examination should be done

women aged 35 years and over. Low-income women

usually do not pay attention to nutritional status and

immunity. Income is very influential on the incidence

of cervical cancer. Low income is difficult to

implement individual hygiene, sanitation and

maintenance of health is lacking. According to

Styarini (Setyarini & Tjakraatmadja, 2009), there is a

relationship between cervical cancer with income,

where women with low incomes are 4 times more at

risk than high-income women.

The results of this study found that the history of

parity has the same distribution that is ≤ 2 and> 2.

Based on research results Hidayat, Hasibuan, and

Fitriyati, (2014). that the parity of more than>3 16.03

times the risk of cervical cancer than people who have

the number of parity <3. Women with high parity are

associated with the evolution of cervical columnar

epithelium during pregnancy which causes a new

dynamic of immature metaplastic epithelium that can

increase the risk of cell transformation and trauma to

the cervix, making it easier for HPV infection (Center

for Disease Control and Prevention Human

Papillomavirus-Associated Cancer United State,

2008).

Hormone changes during pregnancy are likely to

make women are more susceptible to HPV infection

or cancerous growth. In this study most experienced

regular menstruation and the majority of abnormal

papsmear as much as 30%. Irregular menstruation can

be caused by hormonal balance disorders.

The results of this study with non-family history

with papsmear and abnormal IHC. Taking more than

5 years of birth control pills containing progesterone

and estrogen has a bad effect on the uterus, which is

an infection of the uterus and allows a woman to have

uterine cancer (Wahyuningsih & Mulyani, 2014).

It can be concluded that the use of contraception

has an effect on cervical cancer. Oral contraceptives

with high estrogen levels cause adhesions of Candida

albicans which are the bacteria that cause flour

albous. Candida albicans can cause adhesions to the

vaginal epithelium and is a medium for fungal

growth. Candida albicans develops well in pH 5-6.5

environments, these changes can be asymptomatic or

cause infection.

Some journals also mentioned that the use of

mouthwashes such as chlorhexidine, benzydamine,

sodium bicarbonate, granulocyte macrophage

colony-stumulating factor (GM-CSF) showed

ineffectiveness in reducing the degree of mucositis.

The use of chlorhexidine for a long time can cause

tooth discoloration and damage to mucous

membranes.

5 CONCLUSION

1) Most percentage (72.5%) of samples were age

group over 35 years and the majority of normal

and abnormal pap smear at age> 35 years was

37.5%.

2) Most percentage (97.5%) of samples with

married status married with majority result of

abnormal pap smear 47.5%.

3) Percentage of the majority (50%) of women with

high school education with the majority of

abnormal papsmear by 25%

4) Most percentage (67.5%) with status not working

with abnormal pap smear results of 35%.

5) The percentage of parity history has the same

distribution that is ≤2 and> 2 with 50% sample

with parity status of women with the majority of

abnormal pap smear of 32.5 in the history of

parity ≤2.

6) Most percentage (62.5%) of samples with regular

women's menstrual cycles with an abnormal pap

smear majority of 30%.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

540

7) The percentage of most (75%) respondents with

a history of non-FP with a majority of abnormal

pap smear of 37.5%.

8) The percentage of most (70%) samples were age

group over 35 years had IHC intensity 0

(negative p53) and 7.5% intensity +1 (p53

negative) and 2.5% intensity +3 (P53 positive or

protein expression p 53 over expression).

9) The percentage of married marriage status

(87.5%) with majority result of IHC with

intenistas 0 (negative P53) and 7.5% result of

iHC +1 (negative p53) and 2.5% with result of

IHC +3 (P53 positive or protein expression p 53

over expression).

10) The percentage of sample (90%) with IHC

intensity 0 (negative P53) high school (42.5%),

Diploma (15%), Bachelor (32.5%) and IHC

intensity +1 (negative p53) high school (5%),

Diploma (2.5%) and IHC +3 Result (positive p53

/ over p53 expression) of (2.5%).

11) The percentage of sample (60%) with status not

working with resultIHC intenistas 0 (negative

p53), and 5% with result of IHC intensity +1

(negative p53) 5%, and result of IHC +3 (positive

P53) equal to 2.5%.

12) The percentage of samples with parity history

had the same distribution of ≤2 and 22 with 45%

sample with female parity status with IHC

intensity 0 (negative p53) and parity ≤ 2 with

IHC intensity +1 (negative p53) of 2.5% and IHC

intensity +3 result of 2.5%.

13) The percentage of sample (60%) with regular

menstrual cycle with IHC intensity 0 (negative

protein p53), and 2.5% samples with regular

menstrual cycles with IHC +1 (negative p53),

and 5% samples with irregular menstrual cycles

with results IHC +1 (negative p53), and 2.5%

sample with irregular menstrual cycle with IHC

+2 result (negative p53).

14) The percentage of sampel was immune (30%)

with result of IHC intensity 0 (negative p53) and

sample with FP steady at 5% with result of IHC

+1 (negative p53), and Hormonal family

planning sample with IHC +3 result (2.5%).

6 SUGGESTIONS

1) Increasing education activities and health

promotion about cervical cancer prevention by

holding seminar or examination of cervical

cancer detection either Pap smear, IV

examination or IHC examination.

2) For the community to all women play an active

role in the prevention of cervical cancer is to

follow the cervical cancer seminar and early

detection of cervical cancesr examination.

3) For women who have ever done cervical cancer

should re-do periodically at least once a year if

obtained the results are normal and check the

repeat is to do a six-monthly examination.

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