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Agarwal M, Sinha S, Singh G, Singh S, Ahmad S. Attitude and Perceived Barriers Among Highly Educated Women Towards Cervical Cancer Screening by Pap Smear: An Online Survey. Cureus 2022; 14:e28641. [PMID: 36059362 PMCID: PMC9433053 DOI: 10.7759/cureus.28641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
Background Cervical cancer continues to pose a heavy burden on developing countries like India. Early detection of precancerous lesions via Pap smear screening can greatly avert cervical cancer deaths. However, the uptake of cervical cancer screening is poor, and several barriers exist to adequately utilizing screening services. Knowledge of women’s attitudes in the target community is essential for successfully implementing a cervical cancer screening program. Aim This study aimed to provide insight into the attitude and perceived barriers among highly educated women and determine the association between the sociodemographic characteristics and their attitude towards screening. Methods It was an online descriptive study using a questionnaire conducted among highly educated women. Sociodemographic details and the perceived gynecological morbidities were enquired upon. The attitude was measured on a 5-point Likert scale, while practice was assessed by response towards ever screened. Significant barriers to not undergoing cervical cancer screening and determinants of attitude towards screening were evaluated. Results A total of 150 women participated, with a mean age of 36.9+9.7 years. Most (85.33%) women were apparently asymptomatic. Overall, the majority (82.67%) of participants had a favorable attitude toward cervical cancer screening, but only 5.33% of women were ever screened in the past. A major impediment to adequate practice identified was that a Pap test is ‘not required.’ In addition, the women’s age, marital status, and education were found to be significantly associated with women’s attitudes towards screening. Conclusion The study revealed that educated women do possess a favorable attitude towards cervical cancer screening. However, a major gap is still a hindrance between women’s perception and practice. This reiterates the need for a well-designed health educational program focusing on effective information, education, and communication (IEC) strategies and strengthening the national screening program by effectively incorporating it into the health system.
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Mohan L, Karthika M. A community-based cervical cancer screening program in Alappuzha district of Kerala using camp approach. J Family Med Prim Care 2022; 11:1152-1157. [PMID: 35495785 PMCID: PMC9051726 DOI: 10.4103/jfmpc.jfmpc_1260_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Cervical cancer is a major cause of preventable cancer related death in women, particularly in middle-income developing countries. Screening of cervical pre-cancer by cytology remains an effective strategy for prevention of mortality. However, there is paucity of community-based studies in Kerala. The aim of this study was to determine the prevalence of cervical precancerous lesions and to study the associated epidemiological factors through camp approach. Materials and Methods: A cross–sectional study was carried out among women in Alappuzha district, Kerala, by conducting community-based screening camps covering all the panchayaths from February 2017 to January 2019. Statistical Analysis Used: Descriptive statistics including mean for continuous variables and frequency along with their percentage for categorical variables were determined. Pearson’s Chi-square test was used to determine the strength of the association between variables. Statistical significance was set at P value less than 0.05. Results: Out of 5241 women screened, majority (62.9%) were in the reproductive age group (31–50 years) with mean age of 47.1 ± 10.3 years. The prevalence of precancerous lesions of cervix was 6.37%, which consisted of low-grade squamous intraepithelial lesion (LSIL) in 2.2%, high-grade squamous intraepithelial lesion (HSIL) in 0.5% and Carcinoma-in-situ in 0.2%. Risk factors that had significant association with cervical precancerous lesions were lower education status, genital infections, early marriage age and high parity. Conclusion: Well planned community-based screening programs can help to identify the exact prevalence of cervical pre-cancer in a region and the associated epidemiological factors leading to formulation of effective elimination strategies.
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Diouf D, Diop G, Diarra CAT, Ngom AI, Niane K, Ndiaye M, Ka S, Faye O, Dem A. Systematic screening for cervical cancer in Dakar region: prevalence and correlation with biological and socio-demographic parameters. Infect Agent Cancer 2020; 15:24. [PMID: 32336981 PMCID: PMC7178929 DOI: 10.1186/s13027-020-00290-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/08/2020] [Indexed: 12/31/2022] Open
Abstract
Background Cervical cancer is a major public health problem. In 2018, globally 569,847 cervical cancer were diagnosed and 311,000 deaths were projected due to this preventable disease. Worldwide, therefore, the cervical cancer disease ranks as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women in 2018. The high rate of dysplasia in Senegal and the absence of well-organized screening programs informed this study, which aims to determine the prevalence of cervical dysplasia and its relationship to biological and socio-demographic characteristics. Methods This study is based on 1000 conventional smears collected during routine cervical cancer screening at the Gaspard Camara Health Center and the Histology - Embryology and Cytogenetics Laboratory of the Cheikh Anta DIOP University in Dakar. The smears were read according to the Bethesda and Richart systems. However, all data were returned to the Bethesda system using the correspondence table between the different classifications of squamous cell lesions of the cervix. Some of the patients with abnormal smears had colposcopy and if necessary a biopsy. Other patients with low-grade lesions were recommended to have their smears resumed in 6 months or 1 year later. Results Cytological analysis was performed for 1000 patients aged 16 to 82 years (mean age = 41 ± 11.16). Among these, 176 patients had abnormal smears, 23 had Atypical Squamous Cells of Undetermined Significance (ASCUS), 143 had a low-grade lesion, 9 had a high-grade lesion and 1 had carcinoma. Among the remaining 822 patients, cytological analysis revealed no suspected malignant lesions, but 623 among them had dystrophy and 2 were unsatisfactory. Among patients with abnormal smears, 104 patients (23 ASCUS + 71 low grade + 9 high grade + 1 carcinoma) had performed colposcopy, 40 of whom had normal colposcopy and 64 had abnormalities. Sixty-four (64) biopsies were performed. Four (4) were not satisfactory. However, for 26/60 biopsies, the histology was normal, 21/60 had a low grade, 11 displayed a high grade and only 2 had carcinoma. Among the 176 patients with abnormal smears, 72 low-grade patients had undergone cytological examination 6 months to 1 year later to determine the persistence, regression or progression of low-grade dysplasia. During follow-up, persistence was observed in 25% (n = 18) of cases, progression to High-grade squamous intraepithelial lesion (HSIL) was detected in 2.78% (n = 2), while 72.22% (n = 52) of the patients experienced regression. Conclusion In this study, the prevalence of abnormal smear was 17.60% for cytology. Meanwhile, the Colposcopy and histology confirmed just 3.40%. These results underline the interest and need for a review of the discrepancies observed between pathologists.
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Affiliation(s)
- Dominique Diouf
- 1Laboratory of cytogenetic and reproductive biology, Hopital Aristide-Le-Dantec, Pasteur Avenue, PO Box 3001, Dakar, Senegal.,Institut-Juliot-Curie, Hospital Aristide Le Dantec, Pasteur Avenue, PO Box 3001, Dakar, Senegal.,Laboratory of anatomy and pathology, Principal military Hospital of Dakar, Nelson Mandela Avenue, PO Box 3006, Dakar, Senegal.,Cancer Studies and Research Group in Senegal (GERCS), Cheikh Anta Diop Avenue, PO 5005, Dakar, Senegal
| | - Gora Diop
- Cancer Studies and Research Group in Senegal (GERCS), Cheikh Anta Diop Avenue, PO 5005, Dakar, Senegal.,5Department of Animal Biology, Faculty of Science and Technology, Postulant Unit of Genetic, Genomic and Bioinformatic of Infectious Diseases, Cheikh Anta DIOP University, PO Box 55, Cheikh Anta Diop Avenue, Dakar, Senegal.,6Immunology & Biology of infectious diseases Unit, Institut Pasteur Dakar, 36, avenue Pasteur, PO Box 220, Dakar, Senegal
| | | | - Aminata Issa Ngom
- 1Laboratory of cytogenetic and reproductive biology, Hopital Aristide-Le-Dantec, Pasteur Avenue, PO Box 3001, Dakar, Senegal
| | - Khadija Niane
- 6Immunology & Biology of infectious diseases Unit, Institut Pasteur Dakar, 36, avenue Pasteur, PO Box 220, Dakar, Senegal
| | - Moussa Ndiaye
- 6Immunology & Biology of infectious diseases Unit, Institut Pasteur Dakar, 36, avenue Pasteur, PO Box 220, Dakar, Senegal
| | - Sidy Ka
- Institut-Juliot-Curie, Hospital Aristide Le Dantec, Pasteur Avenue, PO Box 3001, Dakar, Senegal.,Cancer Studies and Research Group in Senegal (GERCS), Cheikh Anta Diop Avenue, PO 5005, Dakar, Senegal
| | - Oumar Faye
- 1Laboratory of cytogenetic and reproductive biology, Hopital Aristide-Le-Dantec, Pasteur Avenue, PO Box 3001, Dakar, Senegal.,Laboratory of anatomy and pathology, Principal military Hospital of Dakar, Nelson Mandela Avenue, PO Box 3006, Dakar, Senegal.,Cancer Studies and Research Group in Senegal (GERCS), Cheikh Anta Diop Avenue, PO 5005, Dakar, Senegal
| | - Ahmadou Dem
- Institut-Juliot-Curie, Hospital Aristide Le Dantec, Pasteur Avenue, PO Box 3001, Dakar, Senegal.,Laboratory of anatomy and pathology, Principal military Hospital of Dakar, Nelson Mandela Avenue, PO Box 3006, Dakar, Senegal
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Ghose S, Radhakrishnan V, Bhattacharya S. Ethics of cancer care: beyond biology and medicine. Ecancermedicalscience 2019; 13:911. [PMID: 31123494 PMCID: PMC6467456 DOI: 10.3332/ecancer.2019.911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 11/23/2022] Open
Abstract
Treatable cancers are on the rise due to improved early diagnosis and more innovative treatments, and preventative strategies against cancer are becoming a global concern. With the rapidly increasing complexity of cancer treatment, a clear definition of what constitutes ethical cancer care has become a matter of great debate. This situation is more complex in a developing country where healthcare resources are limited. Doctors, nurses and public health professionals engaged in the prevention, screening, diagnosis, treatment and research of cancers are often posed with ethical dilemmas while making complex choices. With a special focus on low- and middle-income countries, this paper is intended to highlight these real-world ethical concerns facing those involved in the management of cancer patients. While taking a neutral view, this paper has adopted a theme-wise approach to discuss barriers in cancer care.
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Affiliation(s)
- Soumita Ghose
- Administration and Policy, Tata Medical Centre, Kolkata 700156, India
| | - Vivek Radhakrishnan
- Department of Clinical Haematology and Hematopoietic Cell Therapy, Tata Medical Centre, Kolkata 700156, India
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