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

Abstract

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.

Validation of the Cancer Stigma Scale in Nepalese Women

“…High-risk populations are hesitant to undergo cancer screening tests due to fear of being stigmatized, resulting in delayed optimal treatment outcomes (Friedman and Shepeard, 2007;Kwok et al, 2006;Lopez-McKee et al, 2008). A recent study in Nepal identified fear of cancer detection and social stigma as the two most prominent causes for lack of screening (Rademaker et al, 2021). There has been an upsurge of studies on cancer patients' perception of stigma in recent years, but less systematic research into the broader public's perspectives.…”

Factors associated with uptake of breast and cervical cancer screening among Nepalese women: Evidence from Nepal Demographic and Health Survey 2022

“…Nepal consists of people from various ethnicities of which Brahmin/Chhetri are regarded as high caste or advantageous group, and Janajati and Dalit as lower or disadvantageous group. Previous studies suggest that women from the Dalit community compared to high caste groups are relatively easy to convince for health-seeking behavior despite their poor financial and social status [ 15 , 27 ]. This might be the reason for the higher likelihood of BCS uptake among the Dalit group compared to Brahmin women.…”

“…A scoping review states that LMICs including Nepal have inadequate capacity to provide accessible breast and cervical cancer care screening and cancer care. In addition, Nepalese women had low levels of knowledge about breast and cervical cancer, and screening practices for breast and cervical cancer were inadequate among Nepalese women due to sociocultural, geographic, or financial barriers [ 15 ]. Supply-side factors contributing to low rates of screening include lack of skilled healthcare personnel, inadequate availability of equipment, challenges in sample transportation, and low number of laboratories with qualified staff.…”