Call for Systematic Population-Based Cervical Cancer Screening: Findings from Community-Based Screening Camps in Tamil Nadu, India.

Elangovan Vidhubala,Hemant Deepak Shewade,B Sankar Mahadevan,Gomathi Ramaswamy,Anandan K Niraimathi,G Nagalekshmi,Sethupathy Ramkumar

doi:10.31557/apjcp.2019.20.12.3703

Abstract

Background:In India, systematic cervical cancer screening under the national programme is yet to cover the entire population and therefore opportunistic or camp based approach is commonly practiced screening mode currently. This study presents the proportion of screen-positive women [positive visual inspection of the cervix with acetic acid (VIA) and/or Papanicolaou (Pap) smear results] and its associated factors from a rural community-based cervical cancer screening conducted in a service setting. Methods:In this cross-sectional study involving record review, data was drawn from free screening camps conducted by a non-governmental organization in two rural districts of Tamil Nadu, India between March 2015 and March 2017. The associations were assessed using adjusted prevalence ratio with 95% confidence interval. Results:A total of 5,207 women were screened from 307 camps. The mean age was 39.5 years (SD: 8.6). At least one symptom was observed among 2,245 women (43.1%). Of 5,207 women, 19.4% (n=1,009, 95% CI: 18.3%, 20.5%) were screen-positive. Screen positivity in women <30 years was 19%. Age 31-45 years, age at marriage 18-21 years, age at first child birth less than 18 years and unhealthy cervix (on examination) were significantly associated with screen positivity. Conclusion:Reduction in the minimum age of screening from 30 to 21 years considering their marital status and parity, and intensifying awareness campaigns to attract asymptomatic women would be advantageous in early detection and prevention of cervical cancer. Service-based organizations may adopt systematic population-based screening to increase the coverage instead of camp approach.

Highlights

India accounts for one-quarter of the worldwide burden of cervical cancer (Ferlay et al, 2012; Institute for health metrics and evaluation, 2011) and 17% of all cancer deaths among women aged between 30 and 69 years
This study presents the proportion of screen-positive women [positive visual inspection of the cervix with acetic acid (VIA) and/or Papanicolaou (Pap) smear results] and its associated factors from a rural community-based cervical cancer screening conducted in a service setting
Nellai Cancer Care Center (NCCC – based at the district headquarters of Tirunelveli) had formal collaborations with local non-governmental organizations (NGOs) and many of the screening camps were conducted in liaison with NGOs in their field practice

Summary

Introduction

India accounts for one-quarter of the worldwide burden of cervical cancer (Ferlay et al, 2012; Institute for health metrics and evaluation , 2011) and 17% of all cancer deaths among women aged between 30 and 69 years. Due to poor coverage of screening in India irrespective of economic status (rich-6%; poor-4%) (Gakidou et al, 2008), the 5-year relative survival rate for cancer is low (46%) compared to other countries (Sankaranarayanan et al, 2010). Conclusion: Reduction in the minimum age of screening from 30 to 21 years considering their marital status and parity, and intensifying awareness campaigns to attract asymptomatic women would be advantageous in early detection and prevention of cervical cancer. Service-based organizations may adopt systematic population-based screening to increase the coverage instead of camp approach

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