A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings

Pierz, Amanda; Randall, Thomas C.; Castle, Philip E.; Adedimeji, Adebola; Ingabire, Charles; Kubwimana, Gallican; Uwinkindi, François; Hagenimana, Marc; Businge, Lydia; Musabyimana, Francoise; Munyaneza, Athanase; Murenzi, Gad

doi:10.1016/j.gore.2020.100605

Cited by 51 publications

(53 citation statements)

References 57 publications

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“…In our cohort we found a low uptake of cervical cancer screening (44.9%), which has previously been demonstrated in Zambia [39]. This may reflect known barriers to cervical cancer screening such as limited health education and stigma [40]. Indeed, a 2016 cross-sectional study in Lusaka, Zambia found that only 36.8% of participants had heard of cervical cancer and only 20.7% of women had ever attended screening [41].…”

Section: Discussionsupporting

confidence: 45%

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women

et al. 2021

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Background Female genital schistosomiasis (FGS) is a neglected tropical gynaecological disease that affects millions of women in sub-Saharan Africa (SSA). FGS is caused by Schistosoma haematobium, a parasitic carcinogen involved in the pathogenesis of squamous cell carcinoma of the bladder. Cervical cancer incidence and mortality are highest in SSA, where pre-cancerous cervical dysplasia is often detected on screening with visual inspection with acetic acid (VIA). There are no studies evaluating the association between VIA positivity and FGS diagnosed by genital PCR. Methods Women were recruited from the Bilharzia and HIV (BILHIV) study in Zambia a community-based study comparing genital self-sampling to provider obtained cervicovaginal-lavage for the diagnosis of FGS in women aged 18–31. FGS was defined as positive Schistosoma DNA from any genital PCR. Urogenital schistosomiasis diagnostics included urine circulating anodic antigen, urine microscopy and portable colposcopy. Participants were offered cervical cancer screening using VIA at Livingstone Central Hospital. Associations of PCR confirmed FGS and other diagnostics with VIA positivity were assessed using multivariable logistic regression. Results VIA results were available from 237 BILHIV participants. A positive Schistosoma PCR in any genital specimen was detected in 14 women (5.9%), 28.6% (4/14) of these women had positive VIA compared to 9.0% without PCR evidence of schistosome infection (20/223). Schistosoma PCR positivity in any genital specimen was strongly associated with VIA positivity (OR: 6.08, 95% CI: 1.58–23.37, P = 0.02). Conclusions This is the first study to find an association between FGS and positive VIA, a relationship that may be causal. Further longitudinal studies are needed.

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Section: Discussionsupporting

confidence: 45%

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women

et al. 2021

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“…Previous studies in low‐ and middle‐income countries (LMIC) have reported loss to follow‐up rates of 50%–60% among women with abnormal cervical cytology results 5,6 . Reasons for this attrition from care include structural problems such as lack of transportation, long waiting times at clinics, inability to take time off from work, and miscommunication concerning follow‐up visits, in addition to personal reasons such as fear and myths around cancer 5,7‐9 . High loss to follow‐up rates markedly reduce the effectiveness of cervical screening programs.…”

Section: Introductionmentioning

confidence: 99%

Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africa^a

Rohner

Mulongo

Pasipamire

et al. 2020

Intl J Gynecology & Obste

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Objective: To map the cervical cancer screening cascade among women living with HIV attending a public-sector cytology screening program in Johannesburg, South Africa. Methods: We conducted a retrospective cohort study of routinely collected clinical data captured in an electronic medical record system. Women (≥18 years) living with HIV with an abnormal Pap result between January 2013 and May 2018 were included. The proportion of women who received follow-up consistent with extant clinical guidelines, stratified by their initial Pap smear result, was examined. Results: The study included 2072 women: 1384 (66.8%) with a low-risk Pap result, 681 (32.9%) with a high-risk Pap result, and 7 (0.3%) with suspected cancer. Only 174 (25.6%) women with a high-risk Pap result underwent guideline-indicated management within 18 months. Among women with a low-risk Pap result, 375 (27.1%) received follow-up within 1 year; the cumulative incidence of follow-up increased to 63.1% at 3 years. All women with suspected cancer either received a colposcopic biopsy or were referred for further treatment. Conclusion: Attrition among South African women living with HIV who attended cervical screening in an urban public-sector program was high. Developing tailored interventions to address bottlenecks in the care cascade and improve cervical screening outcomes will be central to eliminating cervical cancer.

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“…Multiple articles have found similar barriers to screening as those highlighted in this scoping review. A study in Indonesia reported barriers to CCS including dislike of pelvic exams, discomfort of screening conducted by male HCPs, financial concerns, anxiety regarding abnormal results and the misconception that there is no need for screening when asymptomatic (Spagnoletti et al 2019). Pierz et al (2020 noted that in sub-Saharan Africa, barriers to CCS included lack of knowledge about BC and CC, lack of support from husbands, and the stigmatisation of the utilisation of CCS and BC screening services.…”

Section: Discussionmentioning

confidence: 99%

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

Rademaker

Bhandary

Harder

2021

J Public Health (Berl.)

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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.

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A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings

Cited by 51 publications

References 57 publications

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women

Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africa^a

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

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A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings

Cited by 51 publications

References 57 publications

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women

Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africaa

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

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Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africa^a