Factors influencing early diagnosis of cervical cancer a cros-sectional comparative study

Abstract

ABSTRACT Background: Cervical cancer is the second most commonly diagnosed cancer in the world after breast cancer. It is the most common genital cancer in Kenya and causes most deaths of gynecological cancers. Most of patients at KNH present with late stage clinical disease. HPV is a causative agent with many other risk factors. Early diagnosis is possible using various methods, because cervix is an easily accessible organ. In developed countries, population based screening has reduced morbidity and mortality due to cervical cancer and increased the rate of early diagnosis. Not so for third world countries. Despite late presentation, some women present early with pre-invasive lesions. Objective: To determine the factors that influence early diagnosis of cervical cancer Design: A cross-sectional, comparative study. Setting: Kenyatta National Hospital, Colposcopy clinic for early diagnosis subjects and Radiotherapy clinic for subjects with advanced cervical cancer. Method: Two groups of women were sampled. The first group was those women presenting with dysplastic lesions, while the second group was those with late advanced cervical cancer. Data management: Raw data was entered in a computer. Univariate and multivariate Statistical analysis using appropriate tests and logistic regression analysis was done, to test the significance of dependent and independent characteristics. This PDF is Created by trial version of PDF Converter Pro. Please use purchased version to remove this message. 13 Results: Early diagnosis was associated with higher social economic status than late diagnosis as in 61.9% and 26.3% respectively, were either in business or were professionals (p=0.02). Those with early diagnosis were more likely to have a higher education than those with late diagnosis (55.3% and 32.9% respectively, P‹0.001). Visiting a gynecologist in the previous 5 years was commonly associated with early diagnosis (39.5%) compared to 11.8% of those who had late diagnosis (p‹0.001). Those with early diagnosis were also more likely to have visited a gynecologist more frequently compared to the ones with late diagnosis (76.7% and 11.1% respectively, p=0.004). There was a higher level of awareness on cervical cancer among those with early diagnosis (36.8%) than the ones with late diagnosis (7.9%), p‹0.001. For many women, despite being aware of cervical cancer, fear of screening outcome was reported as a major reason for not screening for cervical cancer (42.9% and 39% with early and late diagnosis respectively, p=0.9). Women of higher social economic status were more likely to source their reproductive health services from private health facilities (38.6%) compared to 7.7% of those with late diagnosis (p‹0.001).There was high perception of lack of community social support by both groups of women with either early or late diagnosis(67.1% and 89.5% respectively, p=0.002. Conclusion: It is concluded that higher education, exposure to knowledge, higher social economic status, previous visit to a gynecologist, and good community social support are associated with early diagnosis of cervical cancer. Recommendations: It is recommended that economic empowerment to women, basic education on cervical cancer, as well as improvement of public health care systems will improve on early diagnosis of cervical cancer.