|Year : 2016 | Volume
| Issue : 1 | Page : 51-54
Knowledge and practices of cervical cancer screening among married women in a semi-urban population of Ludhiana, Punjab
Niji Rachel Varughese, Clarence James Samuel, Pratiba Dabas
Department of Community Medicine, Christian Medical College, Ludhiana, Punjab, India
|Date of Web Publication||22-Dec-2015|
Niji Rachel Varughese
Department of Community Medicine, Christian Medical College, Ludhiana - 141 008, Punjab
Source of Support: None, Conflict of Interest: None
Background and Objectives: Cervical cancer is a leading cause of cancer mortality among women in India. Hence, the objectives of this study were to find out the perception of women towards cervical cancer and assess their health-seeking behavior for screening. Methodology: A cross-sectional study was conducted from November to December 2009 among married women above 15 years of age by systematic random sampling of households in Field Ganj, Ludhiana, India. Information was gathered by a questionnaire assessing the knowledge, attitude, and practices regarding cervical cancer. Results: Of the 304 women interviewed, 28.9% (88) had heard of cervical cancer and 12.2% (37) knew it could be preventable. Only 4.3% (13) of the women had heard about Pap smear. Interpretation and Conclusions: Inadequate knowledge about cervical cancer and Pap smear is the greatest obstacle to effective screening. Identifying individual and community-level barriers is important in increasing cervical cancer screening.
Keywords: Cervical cancer, knowledge, Pap smear, practice, questionnaire, screening
|How to cite this article:|
Varughese NR, Samuel CJ, Dabas P. Knowledge and practices of cervical cancer screening among married women in a semi-urban population of Ludhiana, Punjab. CHRISMED J Health Res 2016;3:51-4
|How to cite this URL:|
Varughese NR, Samuel CJ, Dabas P. Knowledge and practices of cervical cancer screening among married women in a semi-urban population of Ludhiana, Punjab. CHRISMED J Health Res [serial online] 2016 [cited 2020 Mar 30];3:51-4. Available from: http://www.cjhr.org/text.asp?2016/3/1/51/172401
| Introduction|| |
Cervical cancer is the most common cancer among rural women and second most common among the urban women of India. Annually, carcinoma cervix accounts for 130,000 new cases and 20% of all women deaths in India. Cervical cancer has well-known risk factors and an identifiable precancerous stage: Cervical dysplasia. The precancerous and the early stages of invasive cervical cancer can be detected through the visual inspection with acetic acid, visual inspection with Lugol's iodine, and cytological smear examination.,,,, It has been documented that detection at the precancerous or early stage of invasive cancer along with early treatment reduces mortality and morbidity of cervical cancer. Knowledge regarding Pap smear More Details test among women has been proven to be a significant predictor of first-time screening. Moreover, with the availability of the cervical cancer vaccine, the risk for developing cancer cervix is further reduced. Thus, with the right information and resources, cervical cancer is preventable. Has this knowledge trickled down to the susceptible women?
This study was planned with the following objectives:
- To study the perception of women about the risk factors, prevention, early diagnosis, and treatment for cervical cancer
- To assess the women's health-seeking behavior for screening and early detection of cervical cancer.
| Methodology|| |
The urban field practice area of the Community Medicine Department - Field Ganj covers a population of 20,000, where the number of women above 15 years or more was calculated to be 6800. Around 5% of the married women above 15 years of age were selected for this study using systematic random sampling of houses through home visits. The sides of the streets were selected by a flip of a coin, the first house was selected using the last digit of a currency note's serial number and every 3rd house after that was selected. Unmarried women, women who did not consent or were unavailable were excluded. Thus, the study sample was 304. The women were interviewed with a pretested questionnaire in their houses. The questionnaire assessed demographic information of the subjects and knowledge regarding awareness of cervical cancer, its prevention, screening, and detection. The study was conducted from November to December 2009. The data was entered in EpiData entry version 3.1 and descriptive analysis was performed using EpiData analysis program (Developed and released by the EpiData Association from Denmark).
| Results|| |
The characteristics of the surveyed population are mentioned in [Table 1]. The mean age of the population was 35 ± 12.90 years with the age range from 15 to 50 years. Majority of the study population were Hindus (240, 78.9%), and about half of the women had no formal schooling or less than primary-level schooling (153, 50.3%). Married women comprised 92.8% (282) and the remaining were separated, divorced, or widowed. Most of them had more than two children (176, 57.1%). Most of the women were homemakers (269, 88.5%). Majority of the women belonged to poor socioeconomic status (256, 84.2%).
About 28.9% of the women (88) had heard of cervical cancer as a type of cancer, affecting women as mentioned in [Table 2]. Thirty-seven women (12.2%) knew that it could be prevented and 26 women (8.6%) were aware that it could be detected by visual inspection. Thirteen (4.3%) women had knowledge of Pap smear, of whom 5 women thought once in 5 years frequency was adequate. The number of women who were aware of a vaccine for cervical cancer was 20 (6.6%). Moreover 11.8% (36) of the women knew that cervical cancer can be treated. The questions on knowledge regarding the perception of cause of cervical cancer have showed that the multiple sexual partners are considered as a major risk factor as mentioned in [Table 3]. Only 11 (3.6%) women had undergone a gynecological examination for early detection of cervical cancer and 3 (0.9%) women had undergone a Pap smear as in [Table 4], whereas the majority did not know when to do a Pap smear as in [Table 5]. [Table 6] shows the current prevalence of respondents who answered this question.
|Table 6: Current prevalence of risk factors as declared by the participants|
Click here to view
| Discussion|| |
In this study, we assessed the knowledge, attitude, and practices of cervical cancer screening in married women. Of the women surveyed, 28.9% had heard of cervical cancer and 12.2% of women were aware that cervical cancer can be prevented. These results are comparable to similar studies done in North India., Only 4.3% of the women knew about Pap smear, 6.6% were aware of the vaccine, and 11.8% knew cervical cancer could be treated. In keeping with similar other studies done in India, this study shows that, despite being an effective method of controlling cervical cancer, Pap smear continues to be incompletely utilized.,,,,
This is lower than some studies done in Kuwait, Singapore, Vietnamese-American women, the United States,, the United Kingdom,,, Argentina, Kenya, and Nigeria. The differences in the above studies could also be attributed to different populations involved and different levels of intervention such as existing population-based screening programs, or methods to popularize cervical screening.
According to the report on the development of an Atlas More Details of cancer in Punjab state, the district-wise incidence rate of cervical cancer in Ludhiana is high when compared with the incidence rates of the regular population-based cancer registries under the National Cancer Registry Program. The age-adjusted incidence rate of cervical cancer in Ludhiana district is 9.4% in 2012–2013.
Pap smear test for the early detection of cervical cancer is not, by itself, sufficient for reducing the mortality. The positive effect of the test depends on its being properly utilized by the target population. The practice of taking the test depends on a range of factors that include the healthcare system and its professionals and the women themselves. Uptake of screening tests can be improved by understanding individual and community-level barriers including cultural beliefs, stigma, gender inequities, and accessibility to healthcare services.
The greatest obstacle to effective cervical screening is the inadequate knowledge about cervical cancer as well as Pap smear. Utilization of the Pap smear test for cervical cancer screening will not increase unless knowledge is improved, and barriers are eliminated. Providing information through leaflets or mass media campaigns and giving clear explanation about the test procedure can help. Another factor that acts a hurdle to participation in cancer screening, detection, and treatment is the belief that detection of cancer inevitably results in death.
Limitations to this study included the general discomfiture associated with the topic. Since this was a survey conducted by students, the women may not have been very forthcoming in their answers. Lack of intervention following this study may have also prevented them from wanting to comply. Moreover, the fear of the possible outcome of the test and lack of access to health care was found to discourage women from taking the test into consideration.
| Conclusion|| |
Our study indicates that regardless of the test used, a good rate of participation can be achieved in developing countries through the use of appropriate service delivery mechanisms. However, visual inspection methods have the potential to reduce loss to follow-up and therefore, increase coverage. Communication methods and delivery strategies aimed at encouraging older less-educated women, who have less contact with reproductive health services, are needed to further increase screening uptake. Healthcare providers should emphasize the importance of treatment to older, unmarried, and test positive women. Additional research is needed to understand what deters women with more children from receiving treatment.
The authors acknowledge the help of the medical students from the 2008 batch of Christian Medical College, Ludhiana, in data collection. The authors thank Dr. Shavinder Singh, Professor and Head, Department of Community Medicine, Christian Medical College, Ludhiana, and Mr. Jouder BenHur Computer operator for their help, in successful rendering of this manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ferlay J, Bray F, Pisani P, Parkin DM. GLOBACAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, Version 2.0. Lyon: IARC; 2002. Available from: http://www-depdb.iarc.fr/globacan/GLOBOframe.htm
. [Last accessed 2015 Oct 22].
Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, et al.
Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: A cluster-randomised trial. Lancet 2007;370:398-406.
Carr KC, Sellors JW. Cervical cancer screening in low resource settings using visual inspection with acetic acid. J Midwifery Womens Health 2004;49:329-37.
Papanicolaou GN. Introduction of Pap smear in early detection of cervical malignancies. Am J Clin Pathol 1940;19:301-8.
Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P, et al.
Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala, India. Int J Cancer 2003;106:404-8.
Wright TC Jr, Menton M, Myrtle JF, Chow C, Singer A. Visualization techniques (colposcopy, direct visual inspection, and spectroscopic and other visual methods). Summary of task force 7. Acta Cytol 2002;46:793-800.
Roy B, Tang TS. Cervical cancer screening in Kolkata, India: Beliefs and predictors of cervical cancer screening among women attending a women's health clinic in Kolkata, India. J Cancer Educ 2008;23:253-9.
Park K. Textbook of Preventive and Social Medicine. 22nd
ed. Jabalpur: Bhanot Publishers; 2015. p. 411.
Singh M, Ranjan R, Das B, Gupta K. Knowledge, attitude and practice of cervical cancer screening in women visiting a tertiary care hospital of Delhi. Indian J Cancer 2014;51:319-23.
Bailie R, Petrie K. Women's attitudes to cervical smear testing. N Z Med J 1990;103:293-5.
Basu P, Sarkar S, Mukherjee S, Ghoshal M, Mittal S, Biswas S, et al.
Women's perceptions and social barriers determine compliance to cervical screening: Results from a population based study in India. Cancer Detect Prev 2006;30:369-74.
Singh E, Seth S, Rani V, Srivastava DK. Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India. J Gynecol Oncol 2012;23:141-6.
Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer screening: Current knowledge and practice among women in a rural population of Kerala, India. Indian J Med Res 2012;136:205-10.
Anantharaman VV, Sudarshini S, Chitra A. A cross-sectional study on knowledge, attitude, and practice on cervical cancer and screening among female health care providers of Chennai corporation, 2013. J Acad Med Sci 2012;2:124-8.
Al Sairafi M, Mohamed FA. Knowledge, attitudes, and practice related to cervical cancer screening among Kuwaiti women. Med Princ Pract 2009;18:35-42.
Seow A, Wong ML, Smith WC, Lee HP. Beliefs and attitudes as determinants of cervical cancer screening: A community-based study in Singapore. Prev Med 1995;24:134-41.
Nguyen TT, McPhee SJ, Nguyen T, Lam T, Mock J. Predictors of cervical Pap smear screening awareness, intention, and receipt among Vietnamese-American women. Am J Prev Med 2002;23:207-14.
Islam N, Kwon SC, Senie R, Kathuria N. Breast and cervical cancer screening among South Asian women in New York City. J Immigr Minor Health 2006;8:211-21.
Hasenyager C. Knowledge of cervical cancer screening among women attending a university health center. J Am Coll Health 1999;47:221-4.
Yu CK, Rymer J. Women's attitudes to and awareness of smear testing and cervical cancer. Br J Fam Plann 1998;23:127-33.
Sabates R, Feinstein L. The role of education in the uptake of preventative health care: The case of cervical screening in Britain. Soc Sci Med 2006;62:2998-3010.
Jackowska M, von Wagner C, Wardle J, Juszczyk D, Luszczynska A, Waller J. Cervical screening among migrant women: A qualitative study of Polish, Slovak and Romanian women in London, UK. J Fam Plann Reprod Health Care 2012;38:229-38.
Gamarra CJ, Paz EP, Griep RH. Knowledge, attitudes and practice related to Papanicolaou smear test among Argentina's women. Rev Saude Publica 2005;39:270-6.
Gichangi P, Estambale B, Bwayo J, Rogo K, Ojwang S, Opiyo A, et al.
Knowledge and practice about cervical cancer and Pap smear testing among patients at Kenyatta National Hospital, Nairobi, Kenya. Int J Gynecol Cancer 2003;13:827-33.
Asuzu CC, Unegbu J, Akin-Odanye E. Knowledge, attitude and behaviour of the University of Ibadan women towards cancer of the cervix and its prevention. Psychooncology 2012;21:1010-5.
Report of Development of an Atlas of Cancer in Punjab State for the Years 2012-2013. Available from: y
.[Last accessed on 2015 Oct 04].
Krishnan S, Madsen E, Porterfield D, Varghese B. Advancing cervical cancer prevention in India: Implementation science priorities. Oncologist 2013;18:1285-97.
Powe BD, Finnie R. Cancer fatalism: The state of the science. Cancer Nurs 2003;26:454-65.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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