- Volume 14 Issue 7
Background: The majority of cervical cancers, the most prevalent cancer among Nepali women, are diagnosed in advanced stage leading to high mortality in Nepal. The present study explored factors associated with late diagnosis. Materials and Methods: A cross-sectional study was carried out in two specialized cancer hospitals of Nepal from August 12 to October 12, 2012. Randomly selected 110 cervical cancer patients were interviewed and their medical records were reviewed. Multivariate logistic regression analysis was performed to predict associations. Results: Mean age of patients was 52.7years (SD=10.6), 66% were illiterate and 77% were rural inhabitants. Medical shops (33.6%) and private hospitals (31%) were major first contact points of patients with health care providers (HCP). There was no cervical/per-speculum examination (78.2%) and symptoms misinterpretation (90%) of patients occurred in initial consultation with HCP. Four in every five cases (80.9%) of cervical cancer had late diagnosis. Literate women (adjusted OR=0.121, CI: 0.030-0.482) and women having abnormal vaginal bleeding as early symptom (adjusted OR=0.160, CI: 0.035-0.741) were less likely to suffer late diagnosis. Women who shared their symptoms late (adjusted OR=4.272, CI: 1.110-16.440) and did so with people other than their husband (adjusted OR=12.701, CI: 1.132-142.55) were more likely for late diagnosis. Conclusions: High level of illiteracy among women and their problematic health seeking behavior for gynecological symptoms are responsible for late diagnosis of cervical cancer in Nepal. In the absence of a routine screening program, prevention interventions should be focused on raising awareness of gynecological symptoms and improving health seeking behavior of women for such symptoms.
Cervical cancer;symptoms;health care provider;health seeking behavior;late diagnosis;Nepal
- Berraho M, Obtel M, Bendahhou K, et al (2012). Sociodemographic factors and delay in the diagnosis of cervical cancer in Morocco. Pan Afr Med J, 12, 14.
- BPKMCH (2012). Hospital Based National Cancer Registry Program (2007). Bharatpur, Nepal.
- Brewer N, Pearce N, Jeffreys M, White P, Ellison-Loschmann L (2009). Demographic differences in stage at diagnosis and cervical cancer survival in New Zealand, 1994-2005. J Womens Health (Larchmt), 18, 955-63. https://doi.org/10.1089/jwh.2008.1163
- Devi B, Tang T, Corbex M (2007). Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia. Ann Oncol, 18, 1172-6. https://doi.org/10.1093/annonc/mdm105
- Ferlay J, Shin HR, Bray F, et al (2010a). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
- Ferlay J, Shin H, Bray F, et al (2010b). GLOBOCAN 2008 v2.0: Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. Lyon, France: International Agency for Research on Cancer. Available at: http://globocan.iarc.fr.
- Ferrante J, Gonzalez E, Roetzheim R, Pal N, Woodard L (2000). Clinical and demographic predictors of late-stage cervical cancer. Arch Fam Med, 9, 439-45. https://doi.org/10.1001/archfami.9.5.439
- Franceschi S, Plummer M, Clifford G, et al (2009). Differences in the risk of cervical cancer and human papillomavirus infection by education level. Brit J Cancer, 101, 865-70. https://doi.org/10.1038/sj.bjc.6605224
- Hicks ML, Yap OS, Mathews R, Parham G (2006). Disparities in cervical cancer screening, treatment and outcomes. Ethn Dis, 16, 63-6.
- Ibfelt E, Kjaer SK, Johansen C, et al (2012). Socioeconomic position and stage of cervical cancer in Danish women diagnosed 2005 to 2009. Cancer Epidemiol Biomarkers Prev, 21, 835-42. https://doi.org/10.1158/1055-9965.EPI-11-1159
- Ibrahim A, Rasch V, Pukkala E, Aro A (2011). Predictors of cervical cancer being at an advanced stage at diagnosis in Sudan. Int J Women's Health, 3, 385-9.
- Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA: Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
- Joy T, Sathian B, Bhattarai C, Chacko J (2011). Awareness of cervix cancer risk factors in educated youth: a crosssectional, questionnaire based survey in India, Nepal, and Sri Lanka. Asian Pac J Cancer Prev, 12, 1707-12.
- Kaku M, Mathew A, Rajan B (2008). Impact of socio-economic factors in delayed reporting and late-stage presentation among patients with cervix cancer in a major cancer hospital in South India. Asian Pac J Cancer Prev, 9, 589-94.
- Lourenco AV, Fregnani C, Silva P, Latorre MR, Fregnani JHT (2012). Why are women with cervical cancer not being diagnosed in preinvasive phase? An analysis of risk factors using a hierarchical model. Int J Gynecol Cancer, 22, 645-53. https://doi.org/10.1097/IGC.0b013e318246a1af
- Macleod U, Mitchell ED, Burgess C, Macdonald S, Ramirez AJ (2009). Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Brit J Cancer, 101, 92-101. https://doi.org/10.1038/sj.bjc.6605398
- Mayor S (2011). A quarter of patients with cancer see their GP several times before being referred. BMJ, 343, 7601. https://doi.org/10.1136/bmj.d7601
- Pecorelli S (2009). Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet, 105, 103-4. https://doi.org/10.1016/j.ijgo.2009.02.012
- Pradhananga KK, Baral M, Shrestha BM (2009). Multiinstitution hospital-based cancer incidence data for Nepal: an initial report. Asian Pac J Cancer Prev, 10, 259-62.
- Thomson C, Forman D (2009). Cancer survival in England and the influence of early diagnosis: what can we learn from recent EUROCARE results and quest. Brit J Cancer, 101, 102-9. https://doi.org/10.1038/sj.bjc.6605399
- Tran NT, Taylor R, Choe SI, et al (2011). Knowledge, attitude and practice (KAP) concerning cervical cancer and screening among rural and urban female healthcare practitioners in the democratic people's republic of Korea. Asian Pac J Cancer Prev, 12, 3023-8.
- Vinh-Hung V, Bourgain C, Vlastos G, et al (2007). Prognostic value of histopathology and trends in cervical cancer: a SEER population study. BMC Cancer, 7, 164-77. https://doi.org/10.1186/1471-2407-7-164
- Waggoner SE (2003). Cervical cancer. Lancet, 361, 2217-25. https://doi.org/10.1016/S0140-6736(03)13778-6
- World Health Organization (2006). Comprehensive cervical cancer control. A guide to essential practice. Geneva, WHO.
- Yu C, Chiu C, McCormack M, Olaitan A (2005). Delayed diagnosis of cervical cancer in young women. J Gynaecol Obstet, 25, 367-70. https://doi.org/10.1080/01443610500118814
- Relationship Between Prognosis and Neutrophil: Lymphocyte and Platelet:Lymphocyte Ratios in Patients with Malignant Pleural Mesotheliomas vol.15, pp.5, 2014, https://doi.org/10.7314/APJCP.2014.15.5.2061
- Factors Affecting Cervical Cancer Screening Uptake by Hmong Hilltribe Women in Thailand vol.15, pp.8, 2014, https://doi.org/10.7314/APJCP.2014.15.8.3753
- Gynaecological Cancer Mortality in Serbia, 1991-2010: A Joinpoint Regression Analysis vol.16, pp.1, 2015, https://doi.org/10.7314/APJCP.2015.16.1.157
- Factors Associated with Delayed Diagnosis of Cervical Cancer in Iran - a Survey in Isfahan City vol.16, pp.2, 2015, https://doi.org/10.7314/APJCP.2015.16.2.635
- Cervical cancer still presents symptomatically 20 years after the introduction of a structured national screening programme vol.27, pp.4, 2016, https://doi.org/10.1111/cyt.12315
- Social, demographic and healthcare factors associated with stage at diagnosis of cervical cancer: cross-sectional study in a tertiary hospital in Northern Uganda vol.6, pp.1, 2016, https://doi.org/10.1136/bmjopen-2015-007690
- Spousal migration and human papillomavirus infection among women in rural western Nepal vol.8, pp.4, 2016, https://doi.org/10.1093/inthealth/ihw015
- Level of human development is associated with cervical cancer stage at diagnosis pp.1364-6893, 2018, https://doi.org/10.1080/01443615.2018.1463976
- Knowledge, attitude, practice and barriers of cervical cancer screening among women living in mid-western rural, Nepal vol.29, pp.4, 2018, https://doi.org/10.3802/jgo.2018.29.e57
- Symptomatic presentation with cervical cancer in Uganda: a qualitative study assessing the pathways to diagnosis in a low-income country vol.15, pp.1, 2015, https://doi.org/10.1186/s12905-015-0167-4
- Predictors of Locally Advanced Disease at Presentation and Clinical Outcomes Among Cervical Cancer Patients Admitted at a Tertiary Hospital in Botswana vol.28, pp.6, 2018, https://doi.org/10.1097/IGC.0000000000001284