CHAPTER ONE

INTRODUCTION

1.1 Background to study

Cervical cancer is the most common malignancies among females worldwide especially in women of 20–39 years of age. Its contribution to cancer burden is significant across all cultures and economies (Oche et al., 2013). Cervical cancer also accounts for over 270,000 deaths worldwide, an overwhelming majority of which occur in the less developed regions (Imam, 2008). Globally there are over 500,000 new cases of cervical cancer annually and in excess of 270,000 deaths, accounting for 9% of female cancer deaths. 85% of cases occur in developing countries and in Africa (Campbell, 2008). Cervical cancer remained the second leading cause of cancer deaths after breast cancer and the fifth most deadly cancer in women, accounting for approximately 10% of cancer deaths (Okonofua, 2007).  The developing countries have carried a disproportionate share of the burden and 80 % of the 250,000 cervical cancer deaths in 2005 occurred there (WHO, 2007; Uysal & Birsel, 2009). Cervical cancer is the malignant cancer of cervix uteri or cervical area. This happens when normal cells in the cervix change into cancer cells (Arbyn, 2005).

Other factors of low screening rate include perception that one cannot get that disease and fear of vaginal exposure (Gana & Ango 2013). Since health care workers unconsciously and positively act as role models in health-related attitude and behaviour to members of the large society, the health workers need to be encouraged on the importance of taking the Pap smear test so that they can convince other women with whom they interact in the process of discharging their professional duties (Oche et al., 2013). Oche et al., (2013) study was conducted at Sonkoto, Nigeria. The study investigated 240 female health care workers regarding knowledge attitude and practice of cervical cancer screen as a screening procedure for cervical cancer. The findings of the study indicates that 98.6% had heard about Pap smear, 98.6% had good knowledge about cercal cancer and 90.5% knew that cervical cancer can be detected by Pap smear. However, only 10% had ever done a screening test. The health care workers were significantly aware of the preventable nature of the cancer of the cervix but few were willing to utilise the service. Low screening coverage among the health care workers coupled with unwillingness to be screened poses a problem in the early detection of the disease (Oche et al., 2013)

Human Papilloma Virus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. Sexually transmitted human papilloma virus infection leads to the development of cervical intraepithelial neoplasia and cervical cancer (Colgan, 2006).  HPV is spread through sexual contact and although most women’s bodies can fight the infection, sometimes the virus leads to the development of cervical cancer. HPV types 16 and 18 cause 70% of cervical cancer cases, whereas types 6 and 11 cause 90% of genital warts cases. During persistent HPV infection, precancerous changes may be detected in the cervix, that is, readily detectable changes occur in the cells lining the surface of the cervix, therefore early detection and treatment of these changes is an effective strategy for the prevention of cervical cancer and forms the basis of cervical screening programmes (Stephen, 2006). Women with many sexual partners, and those whose partners have had many sexual consorts, or have been previously exposed to the virus, are most at risk of developing the disease (WHO, 2007).

In developed countries of Europe and America that have organized national cervical screening programs, early detection and treatment of precancerous cervical lesions have resulted in a dramatic reduction in the incidence of and mortality from cervical cancer (WHO, 2007). Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can prevent the development of cancer. Cervical cancer is a major risk in women today especially at the age of 20years and above. Awareness of screening programme, preventive vaccination and diet are preventive measures that reduce the incidence of cervical cancer. In developed countries, the widespread use of cervical screening programmes has reduced the incidence of invasive cervical cancer by 50% or more (Population Reference Bureau, 2005).

Cervical cancer is the most common genital tract malignancy of women living in poor rural communities of developing countries (Ferlay, 2006). Such populations lack cervical screening facilities and other basic infrastructural and human resources essential for effective primary healthcare delivery. Symptoms of cervical cancer include; vaginal discharge containing blood, abnormal vaginal bleeding, pelvic pain, blood in urine, bowel symptoms, blood in stool, painful sex, unusual vaginal bleeding, unusual vaginal discharge, contact bleeding, vaginal mass, moderate pain during sexual intercourse, loss of appetite, weight loss, fatigue. Others are loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen leg, heavy bleeding from the vagina and leaking of urine or faeces from the vagina in advanced cases (Duncan, 2005).

Cervical cancer incidence and mortality rates have declined substantially in Western countries following the introduction of screening programmes. The ideal ages of women for screening are 9– 40 years owing to high risk of precancerous lesions due to being sexually active; and a precancerous lesion is detectable for 10 years or more before a cancer develops (Olamijulo, 2005). Although it has been already proven that the efficiency of regular pap tests reduced the mortality rate of cervical cancer, its application in the developing countries is less compared with the developed countries.

In the  developed countries, the widespread use of cervical screening programmes has reduced the incidence of invasive cervical cancer by 50% or more (Yaren, 2008). Cervical cancer is one of the most preventable of all cancers through primary and secondary prevention, prophylactic Human Papilloma virus (HPV) vaccination and cervical screening (Ezem, 2006) Cancer of the cervix remains the most common malignant neoplasm of the female genitalia and the second most common cancer in women (World Health Organization / Institute Catald’ Oncology – WHO/ICO, 2010).  It’s the common cause of death among middle aged women, with an estimated 529,409 new cases and 274,883 deaths in 2008 (WHO/ICO,2010).The hardest – hit regions are countries such as Central and Southern America, the Caribbean, Sub Saharan Africa and part of the Oceania and Asia with the highest incidence over 30/100,000 women (Alliance of Cervical Cancer Prevention- ACCP,2005). An estimated 1.4 million women worldwide are living with cervical cancer and 2 to 5 times more up to 7 million worldwide may have precancerous conditions that need to be identified and treated(ACCP,2005).  In the United Kingdom (UK), cervical cancer is the second most common cancer among females under 35 years of age accounting for 702 new cases in 2007.According to the UK’ statistics report for 2010, 2,828 new cases were diagnosed in 2007.

Furthermore, WHO 2008 asserted that cervical cancer remains a major public health problem. The report further indicates that approximately 500 women develop cervical cancer and 274 deaths occur each year from cervical cancer in developing countries (WHO, 2008).  More than 80% of the world’s new cases and deaths due to cervical cancer occur in the developing world and less than 5%women in these settings are never screened for cervical cancer even once in their life time (McCormick, 2005). Possible reasons for a low participation in cervical cancer screening include; ignorance of the existence of such test, ignorance of importance of screening or lack of risk awareness and the risk factors to the development of cervical cancer, absence of symptoms and lack of awareness of centers where such services are obtainable, and lack of motivation to get screened (Aniebue & Aniebue 2010)

1.2 Statement of the Problem

According to the Cervical Cancer Crisis Card 2013, cervical cancer kills an estimated of 275,000 women every year and 500,000 new cases are reported worldwide. This entirely preventable disease is the second largest cancer killer of women in low and middle-income countries, an estimated 12,990 cases of invasive cervical cancer are expected to be diagnosed in 2016. The cervical cancer incidence rate declined by half between 1975 (14.8 per 100,000) and 2012 (6.7 per 100,000) due to the widespread uptake of screening with the Pap test and removal of precancerous lesions (Sung et al., 2021).

Observed disparities in cervical cancer incidence and mortality are largely accounted for by inequities in cervical cancer screening. In countries with well-organized screening programs, rates of cervical cancer morbidity and mortality have declined significantly. This decline in observed cases of cervical cancer directly corresponds to the adoption of routine cervical cancer screening practice (Burns & Grove 2009). Evidence from Asia, African, and Latin America suggests that many women do not know about cervical cancer screening and are not aware what types of services are available or where and when to seek them. Cervical cancer can be prevented by identifying precancerous lesions early using repeated Pap smear screening and treating these lesions before they Progress to cancer. Prevention, early diagnosis and treatment have been shown to reduce mortality due to cervical cancer (Glanz & Donald 2010). There are various dimensions of factors which affect cervical cancer screening, but little is known about factors associated with cervical cancer screening among women  in Buea Regional Hospital. Therefore, this study aimed to assess knowledge,  practice and prevention of cervical cancer amongst women of child bearing age(15_45)  years in the  bonadikumbo community.

1.3 Research Questions

The aim of the research shall be achieved by answering the following questions;

1. What knowledge do women have on cervical cancer screening?
2. What is the level of acceptability for cervical cancer screening among women?

1.4 Objectives

1.4.1 General Objective

The main aim of this research is to assess the knowledge,  practice and prevention of cervical cancer amongst women of child bearing age(15_45)  years in the  bonadikumbo community.

1.4.2 Specific Objectives

1. To assess the knowledge of women on cervical cancer screening.
2. To determine the level of acceptability for cervical cancer screening among women.