Delay in Diagnosis of Cervical Cancer in Afghanistan: A Pilot Cross-Sectional Survey.

Cecilia Acuti Martellucci,Shohra Qaderi,Shekiba Madadi,Akihiko Ozaki,Mohammad Delsoz,Divya Bhandari,Sayed Hamid Mousavi

doi:10.3389/frph.2021.783271

Abstract

Objectives: The present study aimed to investigate the potential delays in healthcare seeking and diagnosis of women with cervical cancer (CC) in Afghanistan.Methods: Clinical records of three hospitals in Kabul were searched for CC cases, and the women identified were interviewed by a trained physician using a semi-structured questionnaire. The main outcomes were the prevalence of potential delays over 90 days (1) from symptoms onset to healthcare seeking (patient delay), and (2) from first healthcare visit to CC diagnosis (healthcare delay). Information was also collected on: type and stage of CC, diagnostic test utilized, familiarity for CC, signs and symptoms, treatment type, and potential reasons for delaying healthcare seeking.Results: 31 women with CC were identified, however only 11 continued their treatment in the study hospitals or were reachable by telephone, and accepted the interview. The mean age was 51 ± 14 years, and only 18.2% had a previous history of seeking medical care. Patient delay was seen in 90.9% of the women (95% CI: 58.7–99.8), with a median of 304 ± 183 days. Instead, healthcare delay was found in 45.4% (95% CI: 16.7–76.6), with a median of 61 ± 152 days. The main reasons for patient delays were unawareness of the seriousness of the symptoms (70.0%) and unwillingness to consult a healthcare professional (30.0%). None of the women ever underwent cervical screening or heard of the HPV vaccination.Conclusions: Given the global effort to provide quality health care to all CC patients, Afghanistan needs interventions to reduce the delays in the diagnosis of this cancer, for instance by improving all women's awareness of gynecological signs and symptoms.

Highlights

Cervical cancer (CC), caused by oncogenic human papillomavirus (HPV) [1], was responsible for an estimated 604,000 new cases and 341,000 deaths in 2020 and is the leading cause of cancer death in 36 Low- or Middle-Income Countries (LMIC) [2]
The latter were needed because the records were often incomplete, and rarely provided information on the potential delays in healthcare seeking and/or diagnosis which were the main object of this study
The present cross-sectional study, which interviewed women with cervical cancer treated by three hospitals in Kabul, Afghanistan, found widespread considerable delays in healthcare seeking after the onset of signs and symptoms, and fairly frequent, shorter, delays in diagnosis after the first contact with a healthcare provider

Summary

Introduction

Cervical cancer (CC), caused by oncogenic human papillomavirus (HPV) [1], was responsible for an estimated 604,000 new cases and 341,000 deaths in 2020 and is the leading cause of cancer death in 36 Low- or Middle-Income Countries (LMIC) [2]. Instead, concerning LMIC, pilot projects for HPV vaccination are ongoing in some African countries [6, 7], and national or regional screening and vaccination programmes were started in the Pacific area [8], as well as in all countries of Central and South America, with different degrees [9] Despite this unprecedented global momentum, countries which are unstable due to conflict are being left behind [6]. This is the case, in particular, of Afghanistan, where cancer registry data dates back to 1969 [10], and the only recent study on cancer patients was performed on refugees in Pakistan [11, 12]. The aim of the present study was to analyze the characteristics of CC patients in Afghanistan, with a special focus on the potential delays in healthcare seeking and diagnosis

Objectives

Methods

Results

Discussion

Conclusion