Cervical Cancer Screening Program – A Camp Based Cross Sectional Study Among Rural Women in North Kerala

Abstract

Cervical cancer is ranked as the most frequent cancer in women in India and still remains a leading cause of cancer deaths because of high HPV infection rates and lack of comprehensive cervical Pap smear testing of susceptible women. There has been a regular campaign against cervical cancer for 30 years in India, but impact on the morbidity and mortality has been low, with India ranking fourth worldwide. A key challenge for cancer programs is encouraging women in the 30-55 year age group at highest risk for treatable, precancerous lesions, to seek pap smear screening camps. To increase attendance it is important to work in the community by approaching local women's groups and with their help increasing awareness, knowledge and accessibility of screening among women. In this study the investigators made an effort to increase camp attendance by involving women's groups. We assessed the effect of involvement of women groups in comparison to previous camps, the awareness, attitude and practice of the disease, and its prevention, and the HPV vaccine among the women and finally studied the Pap smear results. A camp based cross sectional study was done in Karindalam village to assess pap smear tests, knowledge, attitude and practice regarding cancer cervix and its screening method. Community level women volunteers were used to mobilise women for the camp. Quantitative data was collected through face to face interview using a pre tested questionnaire and the pap smear test done. Analysis was done with descriptive statistics using epi info. There were 319 women who attended the camp. Out of these 99.7% were ever married. In our studied population 55% of the women were married before 20 years of age and 36% had their first child before 20 years of age. Fifty percent studied up to 10 th grade and around 50% belonged to the lower class. Majority of the women had inadequate knowledge about the disease symptoms (52.7%), risk factors (76%), preventive measures (65.5%), Pap smear method (91%) and HPV vaccine (8.4%). Reasons for not doing a Pap smear test so far were inadequate knowledge about the disease and test, fear of procedure and result, non availability of the test locally, being non symptomatic, and cultural factors. The Pap smear tests identified 2 (0.6%) women with high intra epithelial lesions, 4 (1.2%), endocervicitis and 3 (1%) with bacterial vaginosisand adequate follow up was offered. The government of India has to respond to the need of the hour and strengthen information, education and communication efforts on cervical cancer along with providing widespread screening facilities.

Cervical cancer: perception of peripheral health workers in Lucknow: a cross-sectional study

“…13 Vaginal bleeding between periods, pain and bleeding associated with sexual intercourse and foul smelling vaginal discharge were the symptoms known to only about half of the PHWs. This is almost equal to the awareness among rural community women of Tamil Nadu in the study conducted by Krishnaveni et al 18 'Bleeding in post-menopausal women' as a risk factor of cervical cancer was known to only 30 percent of the PHWs. Community women of rural Tamil Nadu had similar awareness (43%) as reported by Krishnaveni et al while nurses and doctors had good (93%) awareness as reported by Anantharaman et al 17,18 Many of the PHWs spuriously perceived that 'multiple abortions' (63.8%), 'leucorrhoea' (53.8%), 'home delivery in past pregnancies' (48.2%) and 'prolonged labour' (31.8%), are the risk factors for cervical cancer.…”

“…This is almost equal to the awareness among rural community women of Tamil Nadu in the study conducted by Krishnaveni et al 18 'Bleeding in post-menopausal women' as a risk factor of cervical cancer was known to only 30 percent of the PHWs. Community women of rural Tamil Nadu had similar awareness (43%) as reported by Krishnaveni et al while nurses and doctors had good (93%) awareness as reported by Anantharaman et al 17,18 Many of the PHWs spuriously perceived that 'multiple abortions' (63.8%), 'leucorrhoea' (53.8%), 'home delivery in past pregnancies' (48.2%) and 'prolonged labour' (31.8%), are the risk factors for cervical cancer. About one fourth (28.7%) of the PHWs spuriously perceived that 'increased frequency of micturition' is a symptom of cervical cancer which was also perceived by 6.8 percent nursing staff at a rural tertiary care hospital in central India.…”

“…13,16,17 But lower levels of awareness was reported among community women of Tamil Nadu (20.5%) and Kolkata (20%). 12,18 Gedam et al reported 54 per cent awareness about 'unprotected sex' as a risk factor for cervical cancer among healthcare professionals of a tertiary care center in Mumbai. 14 Only about one fourth of the ASHAs (19.5%) and BHWs (37.2%) were aware that 'poor sexual hygiene' can increase the risk of cervical cancers.…”

Profile of PAP smears done in a tertiary centre in North Kerala

“…Again, specific knowledge on cervical cancer is a critical element which decides whether a woman will subject herself to pap test. 23 Hence, we believe that in a country like India, setting a target group of women in 30-49 years for cervical screening would never be sufficient to decrease the burden of cervical cancer. 5 There should be continued screening even at old age, especially unless routine screening is followed systematically.…”

“…Community health workers and women volunteers can play a major role in removing the barriers in undergoing PAP test and women empowerment as proven in other studies conducted in India. 23,24 Tertiary centers need active coordination, with secondary and primary health care facilities, to mobilize women to undergo screening, if the latter's facilities and infrastructure are inadequate. Also, there must be strong campaigns and advertisements through media like for breast cancer and HIV-AIDS for health education regarding cervical cancer.…”