Determinants of women's participation in cervical cancer screening trail, Maharashtra, India

Abstract

Objective To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a randomized controlled trial. The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid, cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra, India. Methods Between October 1999 and November 2003 women aged 30-59 years were randomized to receive one of the three tests or to a control group. Participation was analysed for all three intervention arms. The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100 800 eligible women invited for screening. Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high-grade lesions. Participation in screening and compliance with treatment were also analysed according to the type of test used. Findings Compared with women who were not tested, screened women were younger (aged 30-39), better educated and had ever used contraception. A higher proportion of screened women were married and a lower proportion had never been pregnant. Of the 932 women diagnosed with high-grade lesions or invasive cancer, 85.3% (795) received treatment. Women with higher levels of education, who had had fewer pregnancies and those who were married were more likely to comply with treatment. There were no differences in rates of screening or compliance with treatment when results were analysed by the test received. Conclusion Irrespective of the test being used, good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services. Communication methods and delivery strategies aimed at encouraging older, less-educated women, who have less contact with reproductive services, are needed to further increase screening uptake. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

Determinants of Participation in a Breast Cancer Screening Trial in Trivandrum District, India

“…Being currently not married was also reported as a factor for non-compliance in breast and cervical cancer screening programmes (Dinshaw et al, 2007a;2007b;Nene et al, 2007;Taha et al, 2010;Dahlui et al, 2012), for increased distress among cancer patients (Pandey et al, 2006), and for late stage presentation of breast cancer in a hospital in south India (Ali et al, 2008). That women without a husband are less likely to take part in cancer screening programmes might be due to a lack of social support (emotional, informational, tangible, and companionship support) that can negatively affect breast and cervical cancer screening practices (Gamarra et al, 2009;Silva et al, 2009).…”

“…Other studies in India have shown that aging negatively affects participation in breast and cervical cancer screening, referral and treatment (Sankaranarayanan et al, 2003;Dinshaw et al, 2007b;Nene et al, 2007), and was related to delayed presentation of breast cancer (Ali et al, 2008). It is possible that with increasing age it is more are less likely to participate in early detection methods when they feel healthy as well as the fact that screening used to be very uncommon in most LMIC.…”

Social inequality in Pap smear coverage: identifying under-users of cervical cancer screening in Argentina

“…8 Not having the potential emotional and social support provided by husbands and partners has also been given as a possible explanation for this difference. 15 It is important for unmarried women who have ever had sex to be informed that they should have Pap smears, even if they are not currently having sexual intercourse. They might not perceive themselves to be at risk or in need of screening.…”

“…These associations have been reported in a number of other studies as well. 8,15,18,19 The fact that women with no health insurance were more likely to have lower uptake of Pap screening might be linked to deficiencies in service infrastructure in some public health centres in Argentina, where screening for uninsured women should be provided. Studies that have analysed other barriers to Pap smear screening showed that waiting times, availability of counselling and arrangements to assure maximum privacy during the examination are important determinants of women's uptake of Pap tests.…”

“…15,20 Education level is usually considered a surrogate for socio-economic level, 21 but it also influences screening through knowledge, awareness and extent of social inclusion. 22 In our study, education was an independent predictor of screening even after controlling for socio-economic level.…”