Time for an organized cervical cancer screening in Bhaktapur, Nepal

Abstract

Background Cervical cancer is the most common cancer in Nepal and most often they are diagnosed as stage 2 or more. Despite having country’s cancer referral hospital B.P Koirala Memorial Cancer Hospital (BPKMCH), the biggest well equipped in terms of infrastructure, treatment facility and expert manpower is in Bharatpur, organized cervical cancer screening service is not yet exists in this area.

Objective To start a new programme like this it is essential to assess a cervical cancer program and its ability to detect a proportion of possible abnormal cervical smear and assess women’s barrier for attending cervical cancer screening service. Thus the present study aims at identifying determinants of these factors that are necessary for successful cervical cancer screening programme in Bharatpur, Nepal.

Methods Population based cross sectional study was carried out from October 2006 to march 2007. 1547 ever married women aged 15-59 were selected with cluster randomization procedure from ward number 11 Bharatpur municipalities. Ethical clearance to carry out this study was sought from Nepal Health Research council (NHRC) ethical clearance committee. Pap smear test was carried out in BPKMCH and reporting was done on Bethesda system. Interviews were performed using a standard questionnaire pertaining to socio-demographic and reproductive characteristics, their awareness and knowledge regarding cervical cancer and their barriers to utilize the cervical cancer screening service.

Results Out of 1547 total study population 1033 participated in the study and 977of them had Pap smear. Proportion of abnormal cervical smear detected in this study includes ASC: 2.86%, LSIL: 0.2% and HSIL: 0.5%. Thus total prevalence of different grades of abnormal cervical smear was found to be 3.5%. Those who had previous Pap smear 29% belongs to women aged 16-29, 46.6% with aged 30-44 and 42% with aged 45-59. Though 40% have heard of cervical cancer only 26% have responded correctly about the possible prevention and 24.7% responded correctly for its treatable nature when diagnosed early. Health workers role for information dissemination was found lower (47.8%) than mass media and social networks78.5% & 78.5% respectively. Increase proportion of women with awareness of cervical cancer is noted as education level increases and chances of having previous Pap smear among women who have heard of cervical cancer is noted twice than those who have not heard. These differences in proportion were significant with P value of 0.000. 33.2% of the total study population were non participant. Among them 71% were from non slum area compared to 29% from slum area. Major determinants of these women’s barrier were their lack of perception about preventive role of Pap smear, lack of time and lack of permission from there husband to go to cervical cancer screening.

Conclusion Proportion of women with HSIL in our study was not more than other study in developed country, yet cervical cancer is number one malignancy in Nepal. Existence of many societal behavioural patterns in Nepal that are risk to cervical cancer and present opportunistic cervical cancer screening services which have low coverage rate of cervical cancer screening for women with aged 30s and 40s who are considered highest risk group makes the establishment of organized screening service a must. Favourable rate of participation from women with lower socio economic status in our study could be due to free cervical cancer screening service that we have provided. Therefore to reach women with lower socioeconomic status the screening fee must be very nominal. Awareness of cervical cancer is crucial factor to increase cervical cancer screening coverage. Dissemination of proper information to the women, their husband and community at large and inclusion of women’s barrier in the community to cervical cancer information is a pre-requisite to have increase cervical cancer screening coverage.

Key words: Cervical cancer, prevalence, abnormal cervical smear, Pap smear, coverage, organized cervical cancer screening, awareness, knowledge, barriers, Bharatpur, Nepal. This study was done in collaboration with International agency for Research on Cancer (IARC), France and supported by grant through Gates Foundatio