Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

Abstract

Objectives Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. Design This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. Setting We included studies conducted in LMICs published in English between 2010 and 2020. Participants We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. Results Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women. Conclusion A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women’s health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.

Male involvement in female partners’ screening for breast and cervical cancers in Southwest Nigeria

“…This inadequate male involvement is manifest in the poor female cancer screening practices of the women in LMICs [ 12 ]. Underutilization of cervical cancer screening services contributes to late diagnosis and treatment with consequent increased morbidity and mortality.…”

“…Men’s roles in their partners’ RH experiences range from joint decision-making or granting permission to the provision of financial support and transportation [ 11 ]. Recent reviews show that lack of knowledge about female cancers and the role of screening, unsupportive partners and families, cost and fear are major barriers to screening for breast and cervical cancers among women in LMICs [ 12 , 13 ]. The need for spousal approval is also a barrier to cervical cancer screening among Nigerian women [ 14 ].…”

Improving Therapies for Cervical Cancer While Working Toward Eradication

“…13 A recent systematic review on cervical cancer screening in low- and middle-income countries identified several barriers, including cultural or traditional and religious, societal, and health system or structure barriers, as well as lack of knowledge and awareness of cervical cancer in general. 14…”

“…13 A recent systematic review on cervical cancer screening in low-and middle-income countries identified several barriers, including cultural or traditional and religious, societal, and health system or structure barriers, as well as lack of knowledge and awareness of cervical cancer in general. 14 The HPV vaccine has been shown to be effective against anogenital warts and high-grade cervical lesions. A study published in 2020 that included more than 1 million women in Sweden found that the quadrivalent HPV vaccine demonstrated a substantially reduced risk of invasive cervical cancer.…”

Editorial: Anti-cancer effects of natural products against reproductive cancers

“…Cervical cancer is the most common type of gynecologic cancer ( IARC, 2022 ), ranking second in cancer incidence in developing countries ( Motoki et al, 2015 ). Cervical cancer is less prevalent in high-income countries because cervical cancer screening is widely available and effective, and the human papillomavirus (HPV) vaccine is also widely available ( Petersen et al, 2022 ). Jiang et al suggested that Resveratrol may potentiate the effect of cisplatin cis-DDP (cis-dichlorodiamine-platinum (II) in the treatment of cervical cancer.…”