|Year : 2016 | Volume
| Issue : 1 | Page : 42-46
Cervical cancer screening: Awareness, attitude, and practice of Indian women
Sujindra Elamurugan, Praveena Rajendran, Sivashankari Thangamani
Department of Obstetrics and Gynecology, Indira Gandhi Medical College and Research Institute, Puducherry, India
|Date of Web Publication||17-Dec-2015|
Department of Obstetrics and Gynecology, Indira Gandhi Medical College and Research Institute, Puducherry
Background: Cervical cancer is the most common cause of cancer-related deaths among women worldwide. It becomes a deadly disease once it reaches the invasive stages but is very much preventable if detected in its early stages. Cervical cancer screening using Papanicolaou (Pap) test prevents the development of cervical cancer by recognizing the precancerous state. Aims and Objectives: To determine the awareness and attitude and practice of Indian women toward screening for cervical cancer. Materials and Methods: Cross-sectional survey with pretested questionnaires on 200 women belonging to two categories comprising 100 high school teachers and 100 housewives. The questionnaire comprised 15 questions. Four questions were framed to gather the sociodemographic details and the remaining 11 were pertaining to knowledge, attitude, and practice (KAP). The results were tabulated as simple mean and percentage. KAP score was calculated by selecting seven questions from the questionnaire. Scores “1” and “0” were given for positive and negative responses, respectively. Results and Conclusion: Mean age of the teachers was 38.2 ± 13.2 years and of the housewives 40.38 ± 12.2 years. All the teachers had heard about cervical cancer, 98% about the availability of some screening method for cervical cancer, and 79% about Pap smear. Among the housewives, 72% knew about cervical cancer, 70% about the availability of screening methods, and 38% had heard about Pap smear. The practice of cervical cancer screening methods was not adequate among teachers and housewives. However, their knowledge and attitude were welcoming.
Keywords: Attitude, cervical cancer, knowledge, Pap smear, screening
|How to cite this article:|
Elamurugan S, Rajendran P, Thangamani S. Cervical cancer screening: Awareness, attitude, and practice of Indian women. Trop J Med Res 2016;19:42-6
|How to cite this URL:|
Elamurugan S, Rajendran P, Thangamani S. Cervical cancer screening: Awareness, attitude, and practice of Indian women. Trop J Med Res [serial online] 2016 [cited 2020 Sep 23];19:42-6. Available from: http://www.tjmrjournal.org/text.asp?2016/19/1/42/172062
| Introduction|| |
Cervical cancer is the most common cause of cancer-related deaths among women worldwide. Developed countries have reported a significant drop in the incidence of cancer cervix due to intensive screening programs. But, still it is the second most common cancer among women in developing and underdeveloped countries, mounting to 80% of the global burden of this disease. The most common symptom of cervical cancer is abnormal vaginal bleeding. In India, 23.3% of all cancer deaths are due to cervical cancer. Further records from the national cancer registry program show that there is a high incidence in the districts of Tamil Nadu and Puducherry.
Cervical cancer is a deadly disease once it reaches the invasive stages but out of all the female genital tract cancers, it is the only preventable cancer if detected in its early stages. Evidence from the epidemiological and molecular biological studies has established a strong association between human papillomavirus (HPV) serotypes 16 and 18 and cervical cancer. HPV is responsible for more than 90% of invasive cancer and 80% of precancerous lesions in the cervix. Hence, screening for HPV virus infection helps to a great extent in stopping the progression of the precancerous lesions to invasive malignancy.
Cervical cancer screening using the Papanicolaou (Pap) test prevents the development of cervical cancer by recognizing a precancerous state in the cervix and allows 90% of cervical cancers to be identified, treated, and cured before it can spread. Population-based screening with Pap smear is an important secondary preventive measure for cervical cancer that leads to a high-cure rate among cervical cancer patients. Pap smear has been responsible for a 90% decrease in the number of deaths due to cervical cancer in the United States. Unlike the screening programs in developed countries, the ones in developing countries may not succeed due to financial, social, and logistic issues. Further intensive screening programs for cervical cancer have not been established.
Since early detection predicts better prognosis, one of the most effective ways of preventing and controlling cervical cancer is regular screening and early diagnosis. Lack of effective screening programs aimed at detecting and treating precancerous conditions is a key reason for the much higher incidence of cervical cancer in developing countries. But even if intensive screening programs are designed, the success of these programs will depend on the knowledge and attitude of the women who receive them. Hence, the aim of our study was to determine the awareness and attitude of Indian women toward screening for cervical cancer.
| Materials and Methods|| |
This was a cross-sectional survey on 200 women with pretested questionnaires. These 200 women comprised 100 high school teachers and 100 housewives from the union territory of Puducherry. These two categories of people were selected to establish the difference between the employed and unemployed populations. Informed consent was taken from all the participants and confidentiality was assured to all of them. The details were collected using a closed-ended questionnaire. The purpose of the questionnaire was to assess the knowledge, attitude, and practice (KAP) of the participants toward cervical cancer screening methods and Pap smear. The questionnaire comprised 15 questions. Four questions were framed to gather the sociodemographic details and the remaining 11 pertained to KAP.
In order to evaluate KAP, the KAP score was calculated. Seven questions were selected for this purpose. These were “Have you heard of cervical cancer?,” “Have you heard of screening for cervical cancer?,” “Have you heard of Pap test?,” “Have you heard of other tests for screening cervical cancer?,” “Do you think all women above 30 years need to be screened for cervical cancer?,” “Have you been screened for cervical cancer?,” and “If you were explained about Pap smear and an opportunity is given to you to do the test, will you be willing to do the test?” For each of these seven questions, score “1” was given for positive answer and “0” for negative answer. The maximum score was “7” and minimum score was “0". The total score for all the seven answers made the cumulative KAP score.
The collected data were entered in an Excel chart sheet and analysis was done using simple mean and percentage. The KAP score was compared to the sociodemographic characteristics and P value was calculated. P value less than 0.05 was considered statistically significant. Statistical analysis was done using SPSS software version 20 (IBM SPSS Statistics for Windows, Version 20.0, IBM Corporation, Armonk, NY, US).
| Results|| |
The study included 200 participants of whom 100 were high school teachers and 100 were housewives from different randomly selected localities of Puducherry. The sociodemographic profile of the participants is shown in [Table 1]. In the first group “Teachers,” the mean age of the participants was 38.2 ± 13.2 years. Of them, 45% were in the age group of 30-39 years; 75% of teachers were married. The mean parity was 1.2. All of them had received university education. In the second group “Housewives,” the mean age of the participants was 40.38 ± 12.2 years. Of them, 32% were in the age group of 40-49 years; 96% of housewives were married. The mean parity was 1.7. Majority (57%) of them had received secondary education and 3% were illiterate.
The KAP response of women toward cervical cancer screening is shown in [Table 2]. All the teachers had heard about cervical cancer and 98% had heard about the availability of some screening method for cervical cancer. But when asked about Pap smear, only 79% were informed about it. Of all the teachers, 52% agreed that women above 30 years required Pap smear. Of those who had heard of Pap smear, 45.6% and 41.8% had acquired the knowledge from health professionals and books or newspapers, respectively. Of all the teachers, 34.2% correctly answered that Pap smear is required every 3 years; 38% of teachers had undergone screening with Pap smear and most (73.7%) of them only once. All the remaining 62 teachers who had not undergone any screening were ready to get screened if given an opportunity.
Among the housewives, 72% knew about cervical cancer and 70% about the availability of screening methods. Of the all housewives, 38% had heard about Pap smear and only four about other methods. Only 16% of the housewives felt that women above 30 years required screening. Of all the housewives, 15.8% said that Pap smear was required every 3 years. Most (57.9%) of those knew about Pap smear gained their knowledge from health professionals. Only 12% of the housewives had been screened earlier and all of them were screened only once. If given an opportunity for Pap smear, 93.2% of those not screened stated that they were ready to get screened.
The mean KAP score in relation to demographic profile is shown in [Table 3]. For age, the mean KAP score was more in the age group of 40-49 years among teachers and 50-59 years among housewives. But this was not statistically significant. The mean KAP score was high among married women in both the categories and was statistically significant. There was no significant influence of parity and education on KAP score.
| Discussion|| |
Cervical cancer is a preventable disease if detected early. The main key to early detection is screening. The success of any screening program will depend on proper rendering of services, health professionals, easy availability, low cost, and above all the awareness and attitude of women at the receiving end. For this purpose, we studied two different populations of Indian women, teachers and housewives, to analyze their KAP of cervical screening methods. Also, the influence of the different sociodemographic profiles on KAP was analyzed.
The mean age of the participants in our study was 38.2 ± 13.2 years among teachers and 40.38 ± 12.2 years among housewives. This was comparable to another study from Saudi Arabia  in which the mean age was 42 years. A study from Puducherry, India also reported a mean age of 40 years among the patients. In a study from Nepal, the mean age of the participants was 29.9 years.
All the teachers in our study had knowledge about cervical cancer and 98% knew about Pap smear. Among the housewives, 72% knew about cervical cancer and 70% about the screening methods. This difference in knowledge can be attributed to education and employment status. An earlier study from Nepal  reported 65% knowledge among patients visiting a tertiary hospital. Though many have heard about screening methods for cervical cancer, they were not very familiar with the term “Pap smear.” Only 79% of teachers and 38% of housewives knew about Pap smear.
In general, though knowledge about cervical cancer and its screening methods was better among the teachers, they did not have in-depth knowledge about Pap smear. When questioned on its frequency of screening and whom to screen, very few gave the right answer. Majority of the knowledge gained on Pap smear was through health professionals and newspapers. Sait, in his study, reported that 55.6% of women had gained their knowledge through the media and 35.5% through doctors. The Nepal  study reported that 18% of women gained the knowledge from their from peer group and 14% from health professionals. Only 16% among teachers and 4% among housewives were aware of other methods of screening. Hence, even the media and peer groups should start contributing toward imparting knowledge on screening so as to reduce the incidence of cervical cancer.
Though the knowledge among teachers was better when compared to housewives, only 38% of teachers had undergone screening and 3/4th of them underwent it only once. This shows inadequate screening. The status of housewives was even worse. Only 12% of them were already screened. This was consistent with the study from Nepal  on patients in which only 10.5% were reported to have been screened earlier. Apart from the lack of knowledge, the main reason for not being screened was lack of time (29%) among the teachers and embarrassment (13.6%) among the housewives. In a study from Malaysia, the main reason for not being screened was “lack of advice from doctor,” Both the groups, if given an opportunity for screening, were ready to get screened. This shows a very positive attitude of our participants toward screening. Only six participants among the housewives were not willing to be screened. Four of them were very confident that they would not get the disease while two felt embarrassed and shy to undergo screening.
Increase in the mean KAP score with age shows the exposure to increasing health needs with age and hence, more knowledge. Parity and education did not have any significant influence on the KAP score. This could be due to the inadequate sample size to demonstrate the difference. Larger studies will be able to provide better results.
Our study showed that the practice of Pap smear screening was very less but the attitude of our participants toward screening was good. Hence, health programs to improve the awareness of women can help in a great way to reduce the incidence of cervical cancer.
| Conclusion|| |
Knowledge of the teachers was better than that of the housewives, percentage-wise, though education did not show any significant influence on KAP. The practice of cervical cancer screening methods was not adequate among the teachers and the housewives. However, their attitude was welcoming. These findings suggest the need for better health programs to increase the practice of Pap smear among Indian women for better utilization of screening programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Elovainio L, Nieminen P, Miller AB. Impact of cancer screening on women's health. Int J Gynaecol Obstet 1997;58:137-47.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
Nandakumar A, Gupta PC, Gangadharan P, Visweswara RN. National Cancer Registry Programme (NCRP-ICMR): Development of an Atlas of Cancer in India. First All India Report, 2001-2002. Vol. 1 and 2. Bangalore: NCRP; 2010.
Munoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al
. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003;348:518-27.
Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al
. Human papillomavirus is a necessary cause of invasive cervical caner worldwide. J Pathol 1999;189:12-9.
Eddy DM. Screening for cervical cancer. Ann Intern Med 1990;113:214-26.
Sait KH. Attitudes, knowledge, and practices in relation to cervical cancer and its screening among women in Saudi Arabia. Saudi Med J 2009;30:1208-12.
Siddharthar J, Rajkumar B, Deivasigamani K. Knowledge, awareness and prevention of cervical cancer among women attending a tertiary care hospital in Puducherry, India. J Clin Diagn Res 2014;8:OC01-3.
Shrestha J, Saha R, Tripathi N. Knowledge, attitude and practice regarding cervical cancer screening amongst women visiting tertiary centre in Kathmandu, Nepal. Nepal J Med Sci 2013;2:85-90.
Wong LP, Wong YL, Low WY, Khoo EM, Shuib R. Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: A qualitative study. Singapore Med J 2009;50:49-53.
[Table 1], [Table 2], [Table 3]