Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study

Abstract

BackgroundCervical cancer is the leading and most common female cancer among women in Ghana. Although there are screening methods to detect premalignant lesions for treatment, screening coverage in Ghana is 2.8% and late presentation of cases complicates treatment efforts.This study examined the sociodemographic, clinical and histological characteristics associated with late presentation of cervical cancer cases attending Gynecological Oncology care at Catholic Hospital, Battor.MethodsOne hundred and fifty-seven medical records of confirmed cases of cervical cancer reporting to the Outpatient Obstetrics and Gynecology Department between 2012 and 2016 were reviewed. Relevant data were retrieved using abstraction forms. Socio demographic variables investigated were level of education attained, marital status, National Health Insurance Scheme membership, employment status, place of residence and distance from hospital. Clinical variables included intermenstrual/postmenopausal bleeding, previous screening history, previous smoking history, age at menarche and number of children. Histological variables included subtypes of tumour and characteristics of tumour. Pearson’s chi-square test and logistic regression analysis were used to determine correlates of late stage at presentation with cervical cancer. Sensitivity analysis was performed to assess the effect of missing data.ResultsApproximately two-thirds (65.97%) of the cases presented in advanced stages of cervical cancer. Level of education, age at menarche and previous screening history were included in a regression model and adjusted for age. Age at menarche (n = 66) was eliminated from the model after sensitivity analysis. Among the remaining variables, only previous screening history was predictive of late stage at presentation of cervical cancer cases. Previously unscreened cases of cervical cancer were nearly four times more likely to present late, compared to those who had been screened previously (OR 3.91; 95% CI 1.43–10.69). No association was observed with sociodemographic and histological characteristics.ConclusionLack of previous screening was associated with late presentation of cervical cancer at Catholic Hospital, Battor. Efforts to promote early cervical cancer screening should be intensified and future studies may explore an association with age at menarche.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6065-6) contains supplementary material, which is available to authorized users.

Novel use of fine needle aspiration (FNA) biopsy to diagnose cervical cancer in a low‐resource setting: A case series Morovia, Liberia

“…In the present study, one case was diagnosed as adenocarcinoma. All the patients in this study had late presentation, (bulky stage IIB –IV) which is similar to the presentation seen in most low‐resource settings and in a previous assessment of cervical cancer in Liberia 16,17 . The low number of cases diagnosed in this case series does not reflect the prevalence of disease, but can be attributed to limited referral for biopsy since most referring centers were not aware of the availability of FNA biopsy taken directly from the cervix.…”

Characterization of Human Papillomavirus prevalence and risk factors to guide cervical cancer screening in the North Tongu District, Ghana

“…Although the recent national control program for non-communicable diseases (NCDs) states an instituted cervical cancer screening system as a national policy priority, little of the suggested means have been implemented until today [44] and the cervical cancer screening coverage remains low with 2.8% of women aged 25–64 years [45]. This is further highlighted by an analysis including cervical cancer patients from the Catholic Hospital Battor in Ghana, showing that late presentation at the clinic was the main risk factor for cervical cancer diagnosis [5]. The high prevalence of non-vaccine preventable HPV types shows the importance of secondary prevention efforts, even if primary prevention with the available vaccines would be fully implemented.…”

“…Low-middle income countries (LMIC) carry the greatest global burden of cervical cancer with about 85% of incident cases and 87% of annual deaths occurring there [1]. Reasons for this are late presentation at the health facilities [5], poorly developed health systems, lack of financial and technical resources as well as human capacity to diagnose and treat cervical cancer, and often also lack of awareness [6]. This high rate of cervical cancer incidence is projected to increase by 90% until 2030 when considering the current increase in incidence as well as aging and population growth [7].…”

Factors associated with advanced stage at diagnosis of cervical cancer in Addis Ababa, Ethiopia: a population-based study

“…Cervical cancer is the second leading cause of cancer death in women in Ethiopia and other parts of Africa. 1 2 Although cervical cancer can be prevented by detection and removal of precancerous lesions and treated successfully if detected early, 3 most patients in Ethiopia 4 5 and many other parts of Africa are diagnosed at advanced stage of the disease, [6][7][8][9] when the choice of treatment is limited and the probability of survival is less. Previous findings on stage distribution in Ethiopia and in most parts of Africa, however, may not be generalisable as they were hospital-based studies rather than population-based studies.…”