Causes for Late Diagnosis of Cervical Cancer in Three Colombian Border Regions and Strategies to Implement a Program for Its Control

Abstract

Background: Although cervical cancer is preventable through early detection and appropriate treatment, it is still one of the most common cancers in the developing word. In Colombia approximately half of the women diagnosed with cervical cancer die. The purpose of our study was to determine factors associated with delay in the diagnosis of cervical cancer (CC) and to establish strategies for its control in three border regions of Colombia with high number of indigenous and impoverished population.Methods: We conducted a mixed study with convergent triangulation. The study was developed in two stages, first the quantitative component comprising a case-control study, followed by the qualitative component that included interviews and focus groups to healthcare personnel, members of women’s associations, indigenous communities, and quantitative phase´participants. We used the three-delay model as our theoretical framework; this has helped understanding the delay in decision-making by women regarding seeking care (delay 1: individual), arriving at the healthcare institution (delay 2: access), and receiving the appropriate treatment at the institution (delay 3: care and quality).Results: Fifty-five women participated in the quantitative phase, and we conducted 64 interviews and 9 focus groups. Time between the first appointment or Pap smear and final diagnosis was more than two months in 76% of the participants. Delay one was most common among women in La Guajira (higher concentration of indigenous population), and delay two and three in Nariño. Pap smear after 25 years of age (p= 0.002), and more than 3 years apart, once in a lifetime, or never (p< 0.001) were associated with invasive CC. Barriers to undergo a Pap smear were negative experiences with the healthcare system, lack of symptoms, lack of an active sexual life, having only one partner or their partner not having other sexual partners, and fear of the test being painful. The main strategies proposed to prevent and control CC were education, improve actions to promote Pap smear, and human talent strengthening.Conclusion: Even though individual factors played an important role in a delay diagnosis, they are closely influenced by actions of health care services, insurers, and public health actions.