Barriers and facilitators to cervical cancer screening in Nepal: A qualitative study

A scoping review of evidence on routine cervical cancer screening in South Asia: investigating factors affecting adoption and implementation

NEED: Cervical cancer is a major global public health issue, particularly affecting low and middle-income countries, distinctly in the South Asian region. This geographical region lacks a well-organized routine cervical screening program. Consequently, this scoping review aimed to investigate the evidence on factors influencing the adoption and implementation of routine cervical cancer screening in South Asia.

METHODS

Adopting the "Arksey and O'Malley and Levac et al." methodology, databases such as PubMed, CINAHL, Web of Science, and Scopus were scrutinized in the pursuit of relevant studies. Subsequently, the collected data were synthesized by adopting the Consolidated Framework for Implementation Research (CFIR) model.

RESULTS

A total of 837 records were initially identified and screened for eligibility, including 55 studies. The successful adoption and implementation of cervical cancer screening in South Asia encounter numerous obstacles within the health system, including the absence of a comprehensive program protocol for screening, inadequate health infrastructure, and the presence of multiple sociocultural factors, such as social stigma, low levels of education, and concerns related to modesty.

CONCLUSION

To optimize adoption and implementation, it is imperative to construct a customized policy framework that incorporates a risk communication strategy tailored to the specific contexts of these nations. Drawing insights from the experiences of South Asian countries in executing cervical cancer screening programs can inform the formulation of policies for similar healthcare initiatives aimed at facilitating the expansion of HPV vaccination efforts.

Barriers and facilitators for adherence to follow-up by HR-HPV-positive women with premalignant cervical lesions: a mixed-design study in Mexico

BACKGROUND

Mexico reports low follow-up completion rates among women with abnormal cervical cancer screenings. This study aimed to identify barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions in Mexico.

METHODS

A mixed-methods study was conducted from February to April 2019. Participants included women undergoing follow-up care for high-risk human papillomavirus (HR-HPV) and premalignant lesions, along with health personnel from the Women's Healthcare Center (CAPASAM) in Mexico. Quantitative data were obtained from the Women's Cancer Information System and through a questionnaire about factors affecting follow-up adherence. Additionally, the health personnel involved completed a compliance checklist regarding care regulations. Descriptive statistics were used for analysis. Qualitative data were collected via semi-structured interviews with both groups, followed by a content analysis based on identified categories. The Hazard Analysis and Critical Control Point System confirmed care process risks. Proposals to enhance the Early Detection Program for Prevention and Control of Cervical Cancer were collected from a CAPASAM health personnel nominal group.

RESULTS

Identified barriers to follow-up included low income among CAPASAM users, family provider roles limiting time for appointments, long waits for testing and results delivery, distant facilities, insufficient service hour communication, inadequate health personnel training, and a lack of systematic counseling. Hesitation toward follow-up was also linked to shame, apprehension, uncertainty, test aversion, fear of positive results, and limited cervical cancer and screening knowledge. Patriarchal attitudes of partners and limited access to the now-discontinued PROSPERA government program further discouraged follow-up. Facilitators comprised respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes.

CONCLUSIONS

The study found more barriers than facilitators to follow-up adherence, highlighting the need for strategies to bolster the Early Detection Program. Future strategies must address the comprehensive array of factors and incorporate stakeholder perspectives.

The mediating effect of self-efficacy on social support and cancer screening behavior among Chinese women: a cross-sectional study

BACKGROUND

Breast and cervical cancer are the most common cancers in women, and are associated with high morbidity and mortality rates. Cancer screening can facilitate early diagnosis, reduce mortality, and ease the burden of cancer. Social support and self-efficacy are strongly associated with cancer screening behavior. The present study aimed to explore the mediating effect of self-efficacy on social support and cancer screening behavior.

METHODS

In this cross-sectional survey study conducted from June to October 2023, 312 women aged 35-65 years were recruited from the East Coast area of China. A general information questionnaire, cancer screening behavior questionnaire, social support scale and self-efficacy scale were used to collect data. Descriptive statistics were used to analyze the general characteristics of participants; one-way analysis of variance was used to test for differences in the measured variables; and Pearson's correlation analyses were used to describe the relationship among social support, self-efficacy, and cancer screening behavior. A mediation model was constructed and analyzed using the PROCESS macro for SPSS.

RESULTS

The mean (standard deviation) screening behavior score for breast cancer and cervical cancer was 3.98 (2.79), representing an intermediate level. Self-efficacy was closely related to social support and cancer screening behavior. Social support showed a significant positive correlation with self-efficacy (r = 0.37, p < 0.01) and cancer screening behavior (r = 0.18, p < 0.01). Self-efficacy was also significantly positively correlated with cancer screening behavior (r = 0.19, p < 0.05). Self-efficacy showed a full mediating effect between social support and cancer screening behavior, with an explanatory power of 32%.

CONCLUSIONS

The findings emphasize the need to increase women's level of social support and self-efficacy, which in turn can increase women's participation in breast and cervical cancer screening.

Understanding cervical cancer awareness in hard-to-reach areas of Bangladesh: A cross-sectional study involving women and household decisionmakers

INTRODUCTION

In Bangladesh, the uptake of cervical cancer screening is low. Lack of knowledge and understanding of symptoms and risk factors contributes to low screening uptake. The purpose of this study was to explore the knowledge of cervical cancer risk factors and symptoms and to measure the association with socio-demographic characteristics among women and household decisionmakers living in hard-to-reach areas of Bangladesh.

METHODS

A cross-sectional survey was conducted in five districts in Bangladesh among women aged between 30 and 60 years, their husbands, and their mothers-in-law from April to September 2022. Data were collected using a modified version of the validated AWACAN questionnaire tool. The significance level was considered at p-value <0.05 and odds ratios with 95% confidence.

RESULTS

Nearly 50% of participating women in hard-to-reach areas of Bangladesh and their family decisionmakers had low levels of knowledge of the risk factors and symptoms of cervical cancer. Only 20% of respondents in our survey knew about HPV, the most important risk factor for developing cervical cancer. Most respondents were familiar with the terminology of cervical cancer as a disease; however, approximately 40% of respondents did not know that not adhering to cervical cancer screening could be seen as a risk factor. Women do not make decisions about participation in cervical cancer screening on their own. Knowledge of cervical cancer risk factors and symptoms among decisionmakers was significantly associated with higher education and higher household monthly expenditure.

CONCLUSION

Women, their husbands, and mothers-in-law in hard-to-reach areas of Bangladesh had limited knowledge about cervical cancer risk factors and symptoms. Engaging these key decision-makers in targeted health education is vital to improve screening uptake. Conduction of future research to identify and address screening barriers is also essential for effective prevention efforts.

Disparities and Determinants of Testing for Early Detection of Cervical Cancer among Nepalese Women: Evidence from a Population-Based Survey

BACKGROUND

Cervical cancer presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing cervical cancer screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of cervical cancer among Nepalese women.

METHODS

Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (World Health Organization STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30 to 69 years, were used. Respondents were asked if they had undergone cervical cancer testing through visual inspection with acetic acid, Pap smear, or human papillomavirus test ever or in the past 5 years. The slope index of inequality (SII) and relative concentration index were used to measure socioeconomic and education-based disparities in cervical cancer test uptake.

RESULTS

Only 7.1% [95% confidence interval (CI): 5.1-9.9] Nepalese women had ever undergone cervical cancer testing, whereas 5.1% (95% CI: 3.4-7.5) tested within the last 5 years. The ever uptake of cervical cancer testing was 5.1 percentage points higher (SII: 5.1, 95% CI: -0.1 to 10.2) among women from the richest compared with the poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8-21.9).

CONCLUSIONS

Less than one in ten women in Nepal had a cervical cancer testing, primarily favoring higher educated and wealthier individuals.

IMPACT

Targeted early detection and cervical cancer screening interventions are necessary to address these disparities and improve access and uptake.

Examining the availability and readiness of health facilities to provide cervical cancer screening services in Nepal: a cross-sectional study using data from the Nepal Health Facility Survey

OBJECTIVE

We assessed the availability and readiness of health facilities to provide cervical cancer screening services in Nepal.

DESIGN

Cross-sectional study.

SETTING

We used secondary data from a nationally representative 2021 Nepal Health Facility Survey, specifically focusing on the facilities offering cervical cancer screening services.

OUTCOME MEASURES

We defined the readiness of health facilities to provide cervical cancer screening services using the standard WHO service availability and readiness assessment manual.

RESULTS

The overall readiness score was 59.1% (95% CI 55.4% to 62.8%), with more equipment and diagnostic tests available than staff and guidelines. Public hospitals (67.4%, 95% CI 63.0% to 71.7%) had the highest readiness levels. Compared with urban areas, health facilities in rural areas had lower readiness. The Sudurpashchim, Bagmati and Gandaki provinces had higher readiness levels (69.1%, 95% CI 57.7% to 80.5%; 60.1%, 95% CI 53.4% to 66.8%; and 62.5%, 95% CI 56.5% to 68.5%, respectively). Around 17% of facilities had trained providers and specific guidelines to follow while providing cervical cancer screening services. The basic healthcare centres (BHCCs) had lower readiness than private hospitals. Facility types, province and staff management meetings had heterogeneous associations with three conditional quantile scores.

CONCLUSION

The availability of cervical cancer screening services is limited in Nepal, necessitating urgent action to expand coverage. Our findings suggest that efforts should focus on improving the readiness of existing facilities by providing training to healthcare workers and increasing access to guidelines. BHCCs and healthcare facilities in rural areas and Karnali province should be given priority to enhance their readiness.

The impact of DNA tumor viruses in low-to-middle income countries (LMICS): A literature review

DNA viruses are common in the human population and act as aetiological agents of cancer on a large scale globally. They include the human papillomaviruses (HPV), Epstein-Barr virus (EBV), Kaposi sarcoma-associated herpesvirus (KSHV), hepatitis viruses, and human polyomaviruses. Oncogenic viruses employ different mechanisms to induce cancer. Notably, cancer only develops in a minority of individuals who are infected, usually following protracted years of chronic infection. The human papillomaviruses (HPVs) are associated with the highest number of cancer cases, including cervical cancer and other epithelial malignancies. Hepatitis B virus (HBV) and the RNA virus hepatitis C (HCV) are significant contributors to hepatocellular cancer (HCC). Other oncoviruses include Epstein-Barr virus (EBV), Kaposi sarcoma-associated herpes virus (KSHV), human T-cell leukemia virus (HTLV-I), and Merkel cell polyomavirus (MCPyV). The identification of these infectious agents as aetiological agents for cancer has led to reductions in cancer incidence through preventive interventions such as HBV and HPV vaccination, HPV-DNA based cervical cancer screening, antiviral treatments for chronic HBV and HCV infections, and screening of blood for transfusion for HBV and HCV. Successful efforts to identify additional oncogenic viruses in human cancer may provide further understanding of the aetiology and development of cancer, and novel approaches for prevention and treatment. Cervical cancer, caused by HPV, is the leading gynaecological malignancy in LMICs, with high age-standardised incidence and mortality rates, HCC due to HBV is an important cause of cancer deaths, and the burden of other cancer attributable to infections continues to rise globally. Hence, cancers attributable to DNA viruses have become a significant global health challenge. These viruses hence warrant continued attention and interrogation as efforts to understand them further and device further preventive interventions are critical.

Factors affecting cancer screening perception in Turkish women: the role of health literacy

It is suggested that individuals with limited health literacy have less awareness about cancer and screening methods. However, there is a paucity of evidence regarding the relationship between cancer screening perception and health literacy levels among women. This study investigates the determinants of cancer screening perceptions in Turkish women, with a particular emphasis on the influence of health literacy. Employing a cross-sectional design, the study involved 428 women aged 18-69. Data were collected via online questionnaires. Hierarchical regression analysis was utilized to assess the effects of distinct variables on cancer screening perceptions. Exploratory and confirmatory factor analyses were employed to validate and ensure reliability. The results indicated that the constructed hierarchical regression model explicated around 10% of the variance in cancer screening perceptions. Among the various factors examined, health literacy emerged as the most potent predictor of screening perceptions. Individuals possessing higher health literacy demonstrated more favorable attitudes toward cancer screening. Additionally, age surfaced as another notable determinant, with advanced age correlating positively with awareness and receptiveness to screening. This research reveals the pivotal role of health literacy in shaping how Turkish women perceive cancer screening. While a few factors have an impact, the study highlights the urgent need to elevate health literacy levels to foster heightened awareness and engagement in cancer screening programs. The study's findings offer valuable guidance for devising targeted interventions to address disparities in cancer screening perception and participation, particularly among women in low- to middle-income countries such as Turkey.

Exploring the barriers to Pap smear test compliance: A qualitative study for improving cervical cancer screening in the primary health care

Background

Cervical cancer in Iran ranks as the fourth most frequent cancer among women. Pap smear (PS) is the best standard for detecting cervical cancer, but many people, even healthcare providers (HCPs), do not maintain it. HCPs play a critical role in promoting PS uptake. The purpose of the study was to explore barriers to cervical cancer PS screening compliance from the HCPs' perspective.

Methods

The present qualitative content analysis was conducted through semi-structured in-depth interviews. A total of 28 HCPs were interviewed between July and August 2020. A diverse sample of HCPs was selected using purposive sampling. Data analysis was based on the five steps proposed by Graneheim and Lundman. MAXQDA (2020) was used for data analyzing.

Results

Ten key sub-categories were identified and organized into three categories: individual, environmental, and socio-cultural factors. The sub-categories included inadequate risk perception, inappropriate attitude, low commitment, emotional factors, low priority over health, requirements and consequences of the test, deficiencies of health centers, organizational factors, traditions and religious believes.

Conclusion

HCPs face multiple barriers for PS. Exploring and decreasing barriers of PS in HCPs may increase compliance in them and their clients because they play an influential role in instructing and persuading women to take the PS. There is need to explore these barriers and identify possible interventions to change them. Insights from this study are useful for developing policies around national PS programs, too.

Factors influencing cervical cancer re-screening in a semi-rural health district of Cameroon: a cohort study

BACKGROUND

Screening participation at recommended intervals is a crucial component of cervical cancer prevention effectiveness. However, little is known regarding the rate of re-screening in a Sub-Saharan context. This study aimed to estimate the re-screening rate of women in a semi-rural after an initial HPV-based screening and identify factors that influence adherence.

METHODS

This cohort study at the Annex Regional Hospital of Dschang enrolled women screened for cervical cancer over 5 years ago and due for re-screening. Women who initially tested HPV-positive (n = 132) and a random sample of HPV-negative women (n = 220) participated in a telephone survey between October 2021 and March 2022 to assess re-screening participation and reasons. Sociodemographic factors were collected, and associations with rescreening were evaluated.

RESULTS

A total of 352 participants aged under 50 years (mean age 37.4 years) were contacted, and 203 (58.0%) completed the survey. The proportion of women who complied with the screening recommendation was 34.0% (95% CI 27.5% - 40.5%), The weighted re-screening proportion was 28.4%. Age, marital status, education level, type of employment, and place of residence were not associated with the rate of re-screening. Main reported barriers to re-screening were lack of information (39.0%), forgetfulness (39.0%), and impression of being in good health (30.0%). Women who remembered the recommended screening interval were 2 to 3 times more likely to undergo re-screening (aOR (adjusted odds ratio) = 2.3 [1.2-4.4], p = 0.013). Human papilloma virus- positive status at the initial screening was also associated with the re-screening((aOR) (95% CI): 3.4 (1.8-6.5).

CONCLUSION

Following an initial Human Papilloma Virus-based screening campaign in the West Region of Cameroon, one third of women adhered to re-screening within the recommended timeframe. Existing screening strategies would benefit from developing better information approaches to reinforce the importance of repeated cervical cancer screening.

Implementation of cervical cancer prevention and screening across five tertiary hospitals in Nepal and its policy implications: A mixed-methods study

In Nepal, cervical cancer is the most common cancer among women despite the existing policies. This study intends to assess the implementation of cervical cancer prevention and screening through service utilization by women, knowledge and attitude among health professionals, and the perceptions of stakeholders in Nepal. This mixed-methods study was conducted in 2022 across five tertiary hospitals in Kathmandu, Nepal. The quantitative study comprised the health professionals and women attending gynecology outpatient clinics from the selected hospitals. The qualitative study comprised stakeholders including service providers and experts on cervical cancer from selected hospitals, civil societies, and the Ministry of Health and Population. The utilization of screening through pap smear among 657 women across five hospitals was 22.2% and HPV vaccination was 1.5%. The utilization of cervical cancer screening was associated with older age [adjusted odds ratio (AOR) = 1.09, CI: 1.07, 8.19], married (AOR = 3.024, CI: 1.12, 8.19), higher education (AOR = 3.024, CI:1.12, 8.42), oral contraceptives use (AOR = 2.49, CI: 1.36, 4.39), and ever heard of cervical cancer screening (AOR = 13.28, CI: 6.85, 25.73). Among 254 health professionals, the knowledge score was positively associated with them ever having a training [Standardized Beta (β) = 0.20, CI: 0.44, 2.43)] and having outreach activities in their hospital (β = 0.19 CI: 0.89, 9.53) regarding cervical cancer screening. The female as compared to male health professionals (β = 0.16, CI: 0.41, 8.16, P = 0.03) and having a cervical cancer screening guideline as compared to none (β = 0.19 CI: 0.89, 9.53, P = 0.026) were more likely to have a better attitude for screening. The qualitative findings among 23 stakeholders reflected implementation challenges in policy, supply, service delivery, providers, and community. This study showed low utilization of prevention and services by women and implementation gaps on cervical cancer prevention and screening services across five tertiary hospitals in Kathmandu, Nepal. The findings could help designing more focused interventions.

Cancer screening programs in South-east Asia and Western Pacific

BACKGROUND

The burden of cancer can be altered by screening. The field of cancer screening is constantly evolving; from the initiation of program for new cancer types as well as exploring innovative screening strategies (e.g. new screening tests). The aim of this study was to perform a landscape analysis of existing cancer screening programs in South-East Asia and the Western Pacific.

METHODS

We conducted an overview of cancer screening in the region with the goal of summarizing current designs of cancer screening programs. First, a selective narrative literature review was used as an exploration to identify countries with organized screening programs. Second, representatives of each country with an organized program were approached and asked to provide relevant information on the organizations of their national or regional cancer screening program.

RESULTS

There was wide variation in the screening strategies offered in the considered region with only eight programs identified as having an organized design. The majority of these programs did not meet all the essential criteria for being organized screening. The greatest variation was observed in the starting and stopping ages.

CONCLUSIONS

Essential criteria of organized screening are missed. Improving organization is crucial to ensure that the beneficial effects of screening are achieved in the long-term. It is strongly recommended to consider a regional cancer screening network.

Women's perception of barriers and facilitators of cervical cancer Pap smear screening: a qualitative study

OBJECTIVE

Although Pap smear (PS) is considered the best standard in detecting cervical cancer, adherence to timely and regular PS is often lower than global standards in developing countries. Thus, the present study aimed to identify barriers and facilitators of adherence to cervical cancer screening in Mashhad, Iran.

DESIGN

A qualitative content analysis was done from July to December 2022 using semistructured in-depth interviews.

SETTING

The study was conducted in health centres in Mashhad, Iran.

PARTICIPANTS

A sample of 36 married women aged 18-70 years was selected using a purposive sampling, with maximum diversity.

RESULTS

The mean age of participants was 42.8±7.6 years. Among all, 66.7% had the PS test at least once; only 8.3% regularly had the test. The qualitative content analysis led to the extraction of four major themes: (1) individual challenges, (2) environmental limitations, (3) individual motivators, and (4) supportive and efficient environments. The most significant barriers were psychological stress, unhealthy attitudes, insufficient information, cultural issues and insufficient healthcare services. Facilitators included an active and efficient healthcare system, advice and support of important others, and positive emotions and individual beliefs.

CONCLUSIONS

Participants' perceptions showed that the main factors influencing the PS testing were supportive environments, individual motivators, individual challenges and environmental limitations. To encourage women to take the PS and reduce barriers, it may be necessary to revise current health system policies, promote individual and public awareness, reduce psychological stress and correct negative beliefs and attitudes.

A barrier to participation in cervical cancer screenings: fatalism

Cervical cancer is a significant disease affecting women's health in terms of its incidence and is one of the most preventable cancers. However, participation in early cervical cancer-screening programs has been unsatisfactory for various reasons. In this descriptive, relationship-seeking study, we examined the relationship between fatalism tendency, an individual barrier to participation in early cancer screening programs, and women's attitudes toward the early diagnosis of cervical cancer and undergoing the Pap smear test. Research data were collected between August 1, 2019 and December 1, 2019, in a city in northern Turkey from 602 women using a participant information form, the Attitudes Toward Early Diagnosis in Cervical Cancer Scale, and the Fatalism Tendency Scale. We found that fatalistic tendencies in women were a predictor of their attitudes toward the early diagnosis of cervical cancer (odds ratio [OR] = -0.64, β = .47, p < .001) and undergoing the Pap smear test (OR = 1.01, β = -.15, p < .001). Women with high fatalism tendencies had a more negative attitude toward the early diagnosis of cervical cancer and their participation rate in Pap smear screening programs was low. Therefore, nurses must consider women's fatalistic tendencies and attitudes toward cancer when organizing educational and informational programs that encourage participation in cervical cancer screening.

Factors Influencing the Experience of Breast and Cervical Cancer Screening Among Women in Low- and Middle-Income Countries: A Systematic Review

PURPOSE

The persistent high morbidity and mortality from breast and cervical cancer in low- and middle-income countries (LMICs) may be influenced by global disparities in the uptake of screening services. This review sought to synthesize existing evidence to determine factors that influence the experience of women relating to breast and cervical screening in LMICs.

METHODS

A qualitative systematic review of the literature identified through Global Health, Embase, PsycInfo, and MEDLINE. Eligible studies included those outlining primary qualitative research or mixed-method studies with reporting of qualitative findings, detailing women's experiences of involvement with programs for breast or cervical cancer screening. Framework synthesis was used to explore and organize findings from primary qualitative studies and the Critical Appraisal Skills Programme checklist used for quality assessment.

RESULTS

Database searches yielded 7,264 studies for title and abstract screening and 90 full-text articles for screening, with qualitative data from 17 studies and a total of 722 participants included in this review. Four stages influencing experiences of women were generated across both breast and cervical cancer screening approaches, with individual (eg, knowledge of cancer), social (eg, religion, cultural beliefs), and health system (eg, accessibility) factors identified that influence women's initial and subsequent engagement.

CONCLUSION

This study synthesizes existing evidence of factors that influence engagement with breast and cervical cancer screening in LMICs. Evidence-informed recommendations are proposed that may improve the experience of cancer screening in LMICs, with further research necessary to explore their operationalization and impact on cancer care delivery.

Barriers to cervical cancer and breast cancer screening uptake in low- and middle-income countries: a systematic review

There is an alarmingly high growth in breast and cervical cancers in low- and middle-income countries. Due to late presentation to doctors, there is a lower cure rate. The screening programmes in low- and middle-income countries are not comprehensive. In this paper, we systematically analyse the barriers to screening through an accessibility framework. We performed a systematic literature search in PubMed, Mendeley and Google Scholar to retrieve all English language studies (quantitative, qualitative and mixed-methods) that contained information on breast and cervical cancer screening in low- and middle-income countries. We only considered publications published between 1 January 2016 and 31 May 2021. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension (PRISMA-S), an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. The search yielded a total of 67 articles from low- and middle-income countries in this review. We used a framework on accessibility known as the 5A framework, which distinguishes five aspects of access: approachability, acceptability, availability, affordability and appropriateness, to classify the screening barriers. We added two more aspects: awareness and angst, as they could explain other important barriers to screening. They confirmed how the lack of awareness, cost of the screening service and distance to the screening centre act as major impediments to screening. They also revealed how embarrassment and fear of screening and cultural factors such as lack of spousal or family support could be obstacles to screening. We conclude that more needs to be done by policymakers and governments to improve the confidence of the people in the health systems. Women should be made aware of the causes and risk factors of cancer through evidence-based strategies so that there is an increased adherence to screening.

Barriers and facilitators to cervical cancer screening for women from culturally and linguistically diverse backgrounds; a qualitative study of GPs

OBJECTIVE

To explore general practitioners' (GPs) perspectives on the barriers and facilitators to cervical cancer screening (CCS) for women from culturally and linguistically diverse (CALD) backgrounds.

DESIGN

Qualitative descriptive study involving semi-structured interviews, with interview guide informed by the Theoretical Domains Framework.

SETTING

Adelaide, South Australia.

PARTICIPANTS

Twelve GPs with experience in providing CCS to women from CALD backgrounds participated.

RESULTS

Four main themes emerged: 'importance of clinician-patient relationship', 'patients' cultural understanding regarding health care and CCS', 'communication and language' and 'health system related'. Each theme had several subthemes. GPs' professional relationship with their patients and repeated advice from other clinicians, together with the provision of opportunistic CCS, were described as facilitators, and encompassed the theme of 'importance of clinician-patient relationship'. This theme also raised the possibility of self-collection human papilloma virus tests. Lack of awareness and knowledge, lower priority for cancer screening and patients' individual circumstances contributed to the theme of 'patients' cultural understanding regarding health care and CCS', and often acted as barriers to CCS. 'Communication and language' consisted of language difficulties, interpreter use and use of appropriate resources. Language difficulties were a barrier to the provision of CCS, and GPs used interpreters and written handouts to help overcome this. The theme of 'health system related' involved the increased time needed for CCS consults for CALD women, access to appointments, funding, health promotion and effective use of practice management software.

CONCLUSIONS

This study highlights that multiple, inter-related barriers and facilitators influence CALD women's engagement with CCS, and that GPs needed to manage all of these factors in order to encourage CCS participation. More efforts are needed to address the barriers to ensure that GPs have access to appropriate resources, and CALD patients have access to GPs they trust.

Effect of a female community health volunteer-delivered intervention to increase cervical cancer screening uptake in Nepal: a cluster randomized controlled trial

•

A community-based cluster randomized controlled trial.

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An FCHV-delivered intervention increased cervical cancer screening uptake.

•

Screening uptake among women aged 30–60 years in a semi-urban area of Nepal.

This study aimed to assess the effect of Female Community Health Volunteer (FCHV)-delivered intervention to increase cervical cancer screening uptake among Nepalese women. A community-based, open-label, 2-group, cluster randomized controlled trial (CRCT) was conducted in a semi-urban setting in Western Nepal. Fourteen clusters (1:1) were randomly assigned to the intervention group, which received a 12-month intervention delivered by FCHVs or the control group (usual care). Between April and June 2019, 690 women aged 30–60 years were recruited for CRCT during the baseline survey. A follow-up assessment was conducted after the completion of the 12 months intervention. The primary outcome was the change in cervical cancer screening from baseline to 12-month follow-up. Of 690 women, 646 women completed the trial. 254 women in the intervention group and 385 women in the control group were included in the primary outcome analysis. There was a significant increase in cervical cancer screening uptake in the intervention group [relative risk (RR), 1.48; 95 % confidence interval (CI) 1.32, 1.66; P < 0.01)], compared to the control group. The secondary outcome was the change in median knowledge score among women that increased from 2 [interquartile range (IQR) 1–4] (baseline) to 6 [IQR 3–9] (follow-up) in the intervention group. However, the median knowledge score remained almost the same among women in the control group 2 [IQR 1–5] to 3 [IQR 2–5]. Our study findings reported that an FCHV-delivered intervention significantly increased cervical cancer screening uptake among women living in a semi-urban setting in Nepal.

Trial registration: ClinicalTrials.gov NCT03808064.

Role of Paper-Based Sensors in Fight against Cancer for the Developing World

Cancer is one of the major killers across the globe. According to the WHO, more than 10 million people succumbed to cancer in the year 2020 alone. The early detection of cancer is key to reducing the mortality rate. In low- and medium-income countries, the screening facilities are limited due to a scarcity of resources and equipment. Paper-based microfluidics provide a platform for a low-cost, biodegradable micro-total analysis system (µTAS) that can be used for the detection of critical biomarkers for cancer screening. This work aims to review and provide a perspective on various available paper-based methods for cancer screening. The work includes an overview of paper-based sensors, the analytes that can be detected and the detection, and readout methods used.

Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis

OBJECTIVE

To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal.

STUDY DESIGN

Systematic literature review and meta-analysis.

METHODS

PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion.

RESULTS

The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening.

CONCLUSION

Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.

Qualitative factors influencing breast and cervical cancer screening in women: A scoping review

Breast and cervical are top cancers for women globally, but few studies have summarised how gender norms influence screening uptake, given sexual connotations and physical exposure. These beliefs may play a central role in decision-making, and understanding them is crucial to improving screening rates and services. This review scopes international literature for gender-based qualitative factors influencing women’s screening uptake. A systematic search of peer-reviewed English articles in PubMed, Scopus, and CINAHL was conducted from inception until December 2019. Articles were included if they were about breast or cervical cancer screening, had mixed or qualitative methodology, and sampled women from the general population. 72 studies spanning 34 countries were analysed. Eight studies also included healthcare providers’ views. Our narrative thematic analysis summarised primary themes extracted from each study into first-level subthemes, then synthesising second-level and third-level themes: (I) gender socialisation of women, (II) gender inequality in society, and (III) lack of empowerment to women in making screening decisions. Women tended to face sociocultural/role-based constraints, were expected to prioritise family, and keep bodily exposure to their husbands. Women showed low awareness and had fewer opportunities for health education compared to men. Male relations were often gatekeepers to financial resources needed to pay for screening tests. Screening risked community norms about women’s or husbands’ perceived embarrassing sexual behaviours. These findings suggest that interventions targeting unhelpful stigmatising beliefs about women’s cancer screening must concurrently address community general norms, familial role-based beliefs, as well as at male relations who hold the purse-strings.

Communities' perceptions towards cervical cancer and its screening in Wolaita zone, southern Ethiopia: A qualitative study

Background

Cervical cancer is a malignant neoplasm from cells originating in the cervix uteri. Any woman who is sexually active is at risk of getting HPV. Women in sub-Saharan Africa region have higher chance of developing the disease. There are nearly 26 million Ethiopian women who are over the age of 15 and believed to be at risk of getting HPV. Regrettably, Ethiopian women typically present for cervical cancer care at a late stage in the disease, where treatment is most ineffective.

Objectives

To explore communities’ perceptions of cervical cancer and screening among women in Wolaita zone, southern Ethiopia.

Methods

A qualitative research using focused group discussions and in-depth interviews was used to explore communities’ perceptions of cervical cancer and screening among women in Wolaita zone, southern Ethiopia from March 2018-November 2019. The study participants were men, women and communities who were residents of the study settings and were not health professionals. All focused group discussions (FGDs) and key informant interviews were transcribed and entered into Microsoft Word and thematic content analysis was done.

Results

A total of fifty-nine participants participated in both FGD (three with men and six with women) and in-depth interviews (IDIs). Most participants have not heard about cervical cancer but know cancer in general. Participants mentioned that the disease usually relates to many births and unprotected sexual intercourse but none mentioned HPV infection. Most of the participants perceive that cervical cancer is incurable and assume that it could be prevented but they think they are not vulnerable to the disease and screening is not necessary.

Conclusion

This study indicates that rural communities in the zone had limited knowledge about cervical cancer and even less about risk factors, screening, treatment and prevention. There is a great need for cancer education and prevention in Ethiopia.

Knowledge, attitude, preventive practices and utilization of cervical cancer screening among women in Nepal: a community-based cross-sectional study

BACKGROUND

Cervical cancer continues to be a global public health concern and a leading cause of cancer deaths among Nepalese women. In spite of the availability of screening and treatment services in Nepal, the utilization of screening has been low. This study investigated knowledge, attitude, preventive practices and utilization of cervical cancer screening among women in a semi-urban area of Pokhara Metropolitan City of Nepal.

METHODS

A community-based cross-sectional survey was carried out among 729 women 30-60 years of age, between April and June 2019. Participants were selected by systematic random sampling, and a door-to-door home visit was conducted for data collection. A pretested interviewer-administered Nepali questionnaire was used to collect information on sociodemographic variables, knowledge, attitude and preventive practices regarding cervical cancer screening.

RESULTS

The mean age of the participants was 45.9 years (SD ±7.7); the majority were married (86.7%). Among the participants, 44.9% were ever screened for cervical cancer. However, only 10.4% of participants received timely repeated screening for cervical cancer. The median knowledge score achieved by participants was 2.0 [interquartile range (IQR) 1-4] on a scale of maximum score 36, the median attitude score was 31.0 (IQR 29-32) on a scale of 40 and the median preventive practice score was 3.0 (IQR 3-4) on a scale of five.

CONCLUSION

This study showed low knowledge and low utilization of cervical cancer screening among women in Nepal. We recommend a community-based educational intervention to educate and empower women to increase knowledge and utilization of cervical cancer screening.

Knowledge, awareness, attitudes and screening practices towards breast and cervical cancer among women in Nepal: a scoping review

Aim

Breast and cervical cancers have emerged as major global health challenges and disproportionately affect women in low- and middle-income countries, including Nepal. This scoping review aimed to map the knowledge, attitudes and screening practices for these cancers among Nepali women to improve cancer outcomes and reduce inequality.

Methods

Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed), grey literature, and reference and citation lists were searched for articles published in English up to June 2021. Articles were screened against inclusion/exclusion criteria, and data from eligible studies were extracted. Results were summarised narratively.

Results

The search yielded 615 articles, 38 of which were included in this scoping review (27 cervical cancer, 10 breast cancer, 1 both cancers). Levels of knowledge regarding breast and cervical varied widely. The main knowledge gaps were misconceptions about symptoms and risk factors, and poor understanding of screening behaviours. Screening practices were mostly inadequate due to socio-cultural, geographical or financial barriers. Positive attitudes towards cervical screening were associated with higher education and increased knowledge of screening modalities. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated breast cancer screening.

Conclusion

Knowledge and screening practices for breast and cervical cancer among Nepali women were poor and highlight the need for awareness and education programmes. Future research should explore community health worker-led awareness and screening interventions for cervical cancer, and programmes to increase the practice of breast self-examination and clinical breast examinations to support early diagnosis of breast cancer.

Barriers and facilitators in implementing population based common cancer screening through community health workers

Population based cancer screening was initiated in India in 2016 owing to an increased burden of cancers. A feasibility health system study was done by utilising community health workers (CHWs) to conduct the cancer screening. The current study is a qualitative study to elicit the barriers and facilitators in implementing population based cancer screening through CHWs. The study was conducted at three subcentres of Dholai block of Cachar district, Assam, India and Cachar Cancer Hospital and Research Center, Silchar. The participants of the study were CHWs, master trainer nurses and women from community. Three focus group discussions (FGDs) and one in-depth interview (IDI) were conducted at the provider level and seven IDIs of women from the community. The FGDs and IDIs were audio recorded after taking verbal consent from the participants. The verbatims were prepared following translation and transcription and data analysis using ATLAS ti ver 8. The major barrier faced by the community was a lack of motivation to get screened which stemmed from various factors such as personal beliefs, attitudes and fear. The major facilitators were accessibility of tests, family support and CHWs as screening service providers. The major barriers for CHWs were difficulty in motivating the community, lack of support from supervisors and lack of motivation to work. The major facilitators were convenience of screening during home visits, empowerment, skill enhancement and teamwork. Population based cancer screening was a new concept for the community under study. Cancer screening by CHWs was well accepted by the community. Awareness generation among the community was a major factor in improving screening coverage. The study highlights that training and motivation of CHWs can improve the uptake of cancer screening services. CHWs felt empowered with the new skills imparted and were able to carry out screening.

"Cervical cancer screening: awareness is not enough". Understanding barriers to screening among women in West Cameroon-a qualitative study using focus groups

BACKGROUND

Cervical cancer is the second leading cause of cancer-related death among women in sub-Saharan countries, constituting a major public health concern. In Cameroon, cervical cancer ranks as the second most common type of cancer among women and the leading cause of cancer-related deaths, mainly due to the lack of prevention.

OBJECTIVES

Our first and main objective was to understand the barriers affecting women's decision-making process regarding participation in a cervical cancer screening program in the Dschang district (West Cameroon). Second, we aimed to explore the acceptability and perception of a single-visit approach (screen and treat).

METHODS

A qualitative study using focus groups (FGs) was conducted from February to March 2020. Female participants aged between 30 and 49 years and their male partners were invited to participate. Thematic analysis was used, and barriers were classified according to the three-delay model of Thaddeus and Maine.

RESULTS

In total, six FGs with 43 participants (31 women and 12 men) were conducted. The most important barriers were lack of health literacy, low accessibility of the program (in respect to cost and distance), and disrespectful treatment by healthcare workers.

CONCLUSIONS

Our study identified three needs: (1) enhancing health literacy; (2) improving the delivery of cervical cancer screening in rural areas; and (3) providing training for healthcare providers and community healthcare workers to improve patient-provider-communication. Trial registration Ethical Cantonal Board of Geneva, Switzerland (CCER, N°2017-0110 and CER-amendment n°3) and Cameroonian National Ethics Committee for Human Health Research (N°2018/07/1083/CE/CNERSH/SP). NCT: 03757299.

A cross-sectional study to assess knowledge of women about cervical cancer: an urban and rural comparison

INTRODUCTION

Cervical cancer and its etiopathogenesis, the age of women in whom it is diagnosed, average life expectancy, and prognosis are information widely covered in scientific reports. However, there is no coherent information regarding which regions-urban or rural-it may occur more often. This is important because the literature on the subject reports that people living in rural areas have a worse prognosis when it comes to detection, treatment, and life expectancy than city dwellers.

MATERIAL AND METHODS

The subjects of the study were women and their knowledge about cervical cancer. The research was carried out using a survey directly distributed among respondents and via the Internet, portals, and discussion groups for women from Poland. Three hundred twenty-nine women took part in the study, including 164 from rural and 165 from urban areas. The collected data enabled the following: (1) an analysis of the studied groups, (2) assessment of the respondents' knowledge about cervical cancer, and (3) comparison of women's knowledge depending on where they live.

RESULTS

The average assessment of all respondents' knowledge was 3.59, with women living in rural areas scoring 3.18 and respondents from the city-4.01. Statistical significance (p < 0.001) between the level of knowledge and place of residence was determined. The results indicate that an increase in the level of education in the subjects significantly increases the chance of getting the correct answer. In the case of age analysis, the coefficients indicate a decrease in the chance of obtaining the correct answer in older subjects despite the fact that a statistically significant level was reached in individual questions.

CONCLUSIONS

Women living in rural areas have less knowledge of cervical cancer than female respondents from the city. There is a need for more awareness campaigns to provide comprehensive information about cervical cancer to women in rural areas. A holistic approach to the presented issue can solve existing difficulties and barriers to maintaining health regardless of the place of life and residence.

IMPLICATION FOR CANCER SURVIVORS

They need intensive care for women's groups most burdened with risk factors.

Women's knowledge and attitudes towards cervical cancer prevention: A qualitative study in the Spanish context

AIMS AND OBJECTIVES

To explore the knowledge, attitudes and practices related to cervical cancer and its prevention in Spain.

BACKGROUND

Worldwide, women's knowledge about cervical cancer is low, and their attitudes towards its prevention are good, but they do not correlate with the screening uptake. Although the rates of Spanish women performing cervical cancer screening are mostly acceptable, their knowledge and attitudes about it have not been explored.

DESIGN

Qualitative descriptive study.

METHODS

Three focus groups were conducted, with 21 women aged 25 to 65 years. Participants were recruited through convenience sampling. For intragroup homogeneity, women participated in age groups. The COREQ reporting guidelines were used.

RESULTS

Women expressed their knowledge about cervical cancer was low. None of the participants identified the human papillomavirus as a cause of cervical cancer, nor did they mention the vaccine as a preventive measure. They all knew about the screening existence, but not about its frequency nor target population. About the attitudes and practice, 18 women had an appropriate screening, and they were favourable to this health check, claiming an increase in its frequency. Nineteen women claimed they had not received enough information from the healthcare system and a lack of social awareness in comparison with breast cancer. They demanded from the professionals more health education, a reminder of their appointments and a report of the Pap test results.

CONCLUSIONS

There was a self-perceived low level of knowledge about cervical cancer risk factors and its prevention in the participants. However, they expressed favourable attitudes towards screening, and they demanded more information about cervical cancer and its prevention measures, and they regretted its low social awareness.

RELEVANCE TO CLINICAL PRACTICE

Midwives, general nurses and other nurse specialists may have a leading position in health education for cervical cancer prevention in different population levels.

Facilitators and barriers for the delivery and uptake of cervical cancer screening in Indonesia: a scoping review

Background

Cervical cancer (CC) is the second most common female cancer. In Indonesia, national CC screening coverage is low at 12%, highlighting the need to investigate facilitators and barriers to screening.

Objective

This review synthesises research on facilitators and barriers to the delivery and uptake of CC screening; analyses them in terms of supply- and demand-side factors and their interconnectedness; and proposes recommendations for further research.

Methods

Medline Ovid, CINAHL, Global Health, Neliti, SINTA and Google Scholar were searched, applying a search string with keywords relevant to screening, CC and Indonesia. In total 34 records were included, all were publications on CC screening in Indonesia (2000-2020) in English or Indonesian. Records were analysed to identify findings relevant to the categories of barriers and facilitators, supply-and demand-side factors.

Results

Demand-side facilitators identified included:  husband, family or social/peer support (14 studies); information availability, knowledge and awareness (12 studies); positive attitudes and strong perception of screening benefit and the seriousness of CC (12 studies); higher education and socioeconomic status (11 studies); having health insurance; and short distance to screening services (4 studies). Evidence on supply-side was limited. Supply-side facilitators included counselling and support (6 studies), and ease of access (6 studies). Demand-side barriers identified focused on: lack of knowledge/awareness and lack of confidence in screening (14 studies); fear, fatalism and shame (10 studies); time and transportation constraints (8 studies); and lack of husband approval and support (6 studies). Supply-side barriers included: lack of skilled screening providers (3 studies); lack of advocacy and health promotion (3 studies); resource constraints (3 studies); and lack of supervision and support for health care providers (3 studies).

Conclusions

Facilitators and barriers were mirrored in the supply- and demand-side findings. The geographical scope and population diversity of existing research is limited and further supply-side research is urgently needed.

Experiences of cervical cancer survivors in Chitwan, Nepal: A qualitative study

Introduction

Cervical cancer is a global leading cause of morbidity and mortality. The majority of cervical cancer deaths occur in developing countries including Nepal. Though knowledge of cervical cancer is an important determinant of women’s participation in prevention and screening for cervical cancer, little is known about this topic in Nepal. This study explores the experiences of cervical cancer survivors and assesses the attitude of family and community towards it and stigma related to this disease in Bharatpur, Nepal.

Methods

The study design was qualitative methods involving two focus-group discussions. A total of 17 cervical cancer survivors, who have completed two years of cancer treatment were selected purposively from Chitwan. All qualitative data were transcribed and translated into English and were thematically analyzed.

Results

The majority of the participants had scant knowledge about cervical cancer, its causative agent, showed less cervical cancer screening, delayed healthcare-seeking behavior despite having persistent symptoms before the diagnosis. The main reasons identified for not uptaking the cervical screening methods were an embarrassment and having no symptoms at all. Most of them endured social stigma related to cervical cancer in the form of physical isolation and verbal abuse.

Conclusions

There is an urgent need for interventions to make women and the public aware of cervical cancer and launch effective health education campaigns, policies for cervical cancer prevention programs. This implementation can save the lives of hundreds of women and help them avoid going through all the negative experiences related to cervical cancer. More studies are required to gain the perspectives, knowledge, experiences, and attitudes of cervical cancer survivors to add to the research.

Human Papillomavirus and Cervical Cancer Knowledge, Perceptions, and Screening Behavior: A Cross-Sectional Community-Based Survey in Rural Philippines

Background:

Cervical cancer is the second most common cancer among women in the Philippines. Cervical cancer screening is an effective method to reduce incidence. However, screening utilization is limited. This study aims to assess human papillomavirus (HPV) and cervical cancer knowledge, perceptions, and screening utilization, and to investigate factors influencing screening utilization among rural women in the Philippines.

Methods:

This cross-sectional community-based study was conducted among 338 rural women aged 20–50 years, with a child under 5 years old registered in one of four public rural health centers in Tacao Island, Masbate Province in October 2017. A questionnaire administered via face-to-face interviews elicited information about demographic characteristics, knowledge, perceived susceptibility and perceived severity of HPV and cervical cancer, and cervical cancer screening utilization.

Results:

Mean age of participants was 32.5 years. Only 13.9% of participants had ever had cervical cancer screening. Although most women had heard of cervical cancer screening, their knowledge about the cause, risk factors, and preventive measures of HPV and cervical cancer was limited. Older age and higher education status were significantly associated with screening utilization. However, knowledge and perceived susceptibility and severity showed no association. The main reason for having screening was due to a health professional’s request or recommendation, and the reasons for not having screening were cost, not having symptoms, and fear of pain or discomfort and/or embarrassment during the procedure.

Conclusions:

Health education must increase knowledge about HPV and cervical cancer and screening among women, including the nature and progression of cervical cancer, benefits of screening, screening cost, and screening procedure. Health care providers have an important role in educating and motivating women to undergo screening.

Exploring the Barriers to Cervical Cancer Screening through the Lens of Implementers and Beneficiaries of the National Screening Program: A Multi-Contextual Study

BACKGROUND

Cervical cancer is a major reason for morbidity and mortality in Low and Middle income countries. The National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) sets out broad national guideline to implement Cervical cancer screening. However, an implementation strategy for cervical cancer screening is not in place for districts. Although opportunistic screening takes place, implementation is hindered by psychological and physical barriers for women, as well as insufficient capacity on the part of implementers. This qualitative study aims to identify the specific barriers that prevent the uptake of cervical cancer screening.

METHODS

Women who could benefit from cervical cancer program were interviewed to explore the factors that influenced their uptake of the cervical screening offered. Key informant interviews were conducted with implementers of the NPCDCS and with public health staff of three States (Himachal Pradesh, Meghalaya and Karnataka), to understand their perception of determinants of the utilization of screening services.

RESULTS

The general health concern among the participants was low, and routine check-ups were considered unimportant. Poor knowledge about cervical cancer, benefits of screening service availability, as well as a general sense of well-being, embarrassment or anxiety related to the screening procedure, fear of being judged for lack of modesty, and stigma were common barriers to screening uptake. In addition to a general unawareness of cervical cancer geographical inaccessibility of screening as a barrier to participate in cervical cancer screening, in certain regions.

CONCLUSION

It is essential to increase the knowledge on cervical cancer and on the benefits of screening among Indian women. Providing information and cues to action by health workers and professionals can facilitate the decision to participate. Implementers need to be involved to ensure context specific implementation of the National programme to overcome these barriers.

Barriers and facilitators to cervical cancer screening uptake among women in Nepal - a qualitative study

The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annually. Almost 90% of cervical cancer deaths occur in low and middle income countries. Screening is the most effective tool in prevention, early diagnosis, and treatment of cervical cancer. Nepal has no national cervical cancer screening programme, and data from 2003 showed that only 2.8% of Nepalese women had ever been screened. We conducted a qualitative study to obtain better insight into barriers and facilitators to cervical cancer screening among women in Nepal to generate data to inform interventions. In February 2019, four focus group discussions with previously screened and non-screened women, and Female Community Health Volunteers and four in-depth interviews with health workers were conducted in Pokhara Metropolitan City. Semi-structured interview guides were used, interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory approach with open coding. This resulted in five main themes: 1) lack of husband's support for screening, 2) prevalent stigma and discrimination, 3) lack of awareness about screening options, 4) getting screened, and 5) health care providers. We encourage policymakers and stakeholders apply these findings to improve awareness, access to information, and better screening services in Nepal.

Analyzing Awareness on Risk Factors, Barriers and Prevention of Cervical Cancer among Pairs of Nepali High School Students and Their Mothers

Providing information on increased cancer risks associated with certain behaviors might encourage adolescents to initiate protective behaviors. This study firstly determined the knowledge of risk factors and prevention of cervical cancer. Secondly, it checked an association between mothers' screening practice and student's knowledge. A descriptive, cross sectional study was conducted among 253 pairs of high school students and their mothers. Knowledge on cervical cancer was significantly lower among students and mothers. While cancer screening tests, maintenance of hygiene were considered as major preventive measures for cervical cancer, human papilloma vaccine was the least considered preventive measure. Students who were female, attended discussions on cancer and had a healthy diet had better awareness of cancer. Mothers of female students had better knowledge about cervical cancer than mothers of male students. Less perceived susceptibility and lack of knowledge were major obstacles among mothers, limiting cervical cancer screening to 15%. Although association between knowledge of students and screening practice of mothers was not clear, it was observed that cancer communication increased awareness of cervical cancer in both groups. Our findings showed a strong need for school-based cancer education program to address the issues of human papillomavirus vaccinations, cervical cancer risk and screening.

Smokeless tobacco use and oral neoplasia among urban Indian women

OBJECTIVES

Oral cavity cancers are fourth most common cancers among Indian women. The objectives were to create cancer awareness (CA) and screen tobacco-using women for oral cavity cancers.

MATERIALS AND METHODS

A community-based CA and screening programme was conducted among women in Mumbai, India. The tobacco-using women participated in CA and oral cavity screening by oral visual inspection (OVI). All screen-positive women were referred to nodal hospital and assisted for diagnostic confirmation and treatment completion.

RESULTS

Twelve slum clusters comprising of 138,383 population and 13,492 tobacco-using women have been covered. Among them, 11,895 (88.2%) participated in CA and 11,768 (87.2%) in OVI. A total of 377 (3.2%) women were screened positive, 275 (72.9%) complied with referral and 207 oral precancers [173 leukoplakia, 9 erythroplakia, 3 erythroleukoplakia and 41 sub-mucus fibrosis (SMF) including 35 women with multiple precancers] and 7 oral cancers were diagnosed. The detection rate of oral precancerous lesions and oral cancers was 17.6 and 0.6 per 1,000 screened women. Thirty-five women had multiple oral precancerous lesions. The results of multivariate analysis indicate dose-response relationship between tobacco use and risk of oral precancers.

CONCLUSION

Good participation rates (>85%) for cancer awareness and OVI were seen among urban slum women in India. Many oral precancer and cancer cases were detected and were managed at the nodal hospital.