Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana

Abstract

Background Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. Results There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47–0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02–1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70–3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02–2.55). Conclusion Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.

Evaluating the geographic distribution of cervical cancer patients presenting to a multidisciplinary gynecologic oncology clinic in Gaborone, Botswana

“…We also identified that a potential area for intervention to mitigate the cervical cancer burden at the individual level could be to increase efforts for women without HIV, including assessing and improving knowledge in this population related to cervical cancer and cervical cancer screening. This finding is consistent with our previous studies [ 44 , 45 ] indicating that access to care may be differential according to HIV status in Botswana. Our previous study [ 45 ] noted that WLWH were more likely to report having had cervical cancer screening (62% of WLWH reported cervical cancer screening versus 48% of women without HIV).…”

Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review

“…We also found studies conducted in Ghana ( n = 6) ( 50 , 71 , 111 , 123 , 134 , 155 ), Kenya ( n = 5) ( 70 , 96 , 115 , 132 , 139 ), Zambia ( n = 4) ( 44 , 77 , 102 , 126 ), and Eritrea ( n = 3) ( 60 – 62 ). There were seven countries with two studies each [Botswana ( 43 , 47 ), the Central African Republic ( 31 , 32 ), Mozambique ( 57 , 58 ), Rwanda ( 130 , 136 ), Senegal ( 147 , 156 ), Sudan ( 84 , 114 ) and Zimbabwe ( 38 , 39 )]. The countries with a single study were Cote d'Ivoire ( 128 ), Democratic Republic of Congo ( 99 ), Mali ( 85 ), Swaziland ( 76 ), Tanzania ( 49 ), and The Gambia ( 30 ).…”

“…One cross-sectional study was conducted in each of the following countries: Côte d'Ivoire ( 128 ), the Democratic Republic of Congo ( 99 ), Ghana ( 111 ), Rwanda ( 130 ), and Senegal ( 147 ). There was also one retrospective record review of patient files from Botswana ( 47 ) and another retrospective record review of smears from Swaziland (now called Eswatini) ( 76 ).…”

Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study

“…This method was used to triangulate and compare cross-cutting domains of inquiry collected qualitatively and quantitatively [ 13 ]. Participants interviewed in this study were part of a larger clinical cohort study of over 1,000 patients with cervical cancer designed to assess longitudinal treatment outcomes [ 10 , 14 ].…”

“…Despite significant progress and investment in HIV treatment and cervical cancer screening programs in Botswana both by the Government of Botswana and donors, incidence of cervical cancer remains very high [ 7 , 8 ]. Most cervical cancer patients present at advanced stages and about half of the women with cervical cancer report that they have never been screened for cervical cancer [ 8 – 10 ]. While previously published literature points to lack of cervical cancer awareness among women in Botswana, little is known about how individual, community, or system-level factors shape delays across screening and diagnostic pathways from the perspective of women themselves or how delays may be amplified or attenuated for women living with HIV [ 11 , 12 ].…”