(PDF) Proposal on Knowledge and Acceptability of Cervical Cancer Screening Among Female Students of Federal Polytechnic Ado

INTRODUCTION

Cervical cancer is the second most common cancer in the women worldwide and the leading cause of cancer deaths among women in developing countries (GLOBOCAN 2008). Cervical cancer is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up. Two screening tests can help prevent cervical cancer or find it early—The Pap test (or Pap smear) looks for pre-cancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The Pap test is recommended for all women between the ages of 21 and 65 years old, and can be done in a doctor’s office or clinic. The HPV test looks for the virus (human papillomavirus) that can cause these cell changes (Centers of Disease Control and prevention 2006).

In USA, American Cancer Society (ACS) inaugurated a yearly report on its cancer screening guidelines in California: A Cancer Journal for Clinicians. The report, and subsequent annual reports, has provided a summary of ACS cancer screening guidelines, about testing for early cancer detection for tests that are increasingly used by the public. In order for guidelines to reflect the most current scientific evidence, the guidelines have been updated more frequently as new evidence or the emergence of new technologies have warranted more frequent updates in guidance to health professionals and the public (http://cajournal.org). The age-adjusted annual incidence rate of cervical cancer is 6.6 cases per 100,000 women, according to data from National Cancer Institute; 2011. An estimated 12,200 new cases of cervical cancer and 4210 deaths occurred in the United States in 2010. Cervical cancer deaths in the United States have decreased dramatically since the implementation of widespread cervical cancer screening. Most cases of cervical cancer occur in women who have not been appropriately screened. Strategies that aim to ensure that all women are screened at the appropriate interval and receive adequate follow-up are most likely to be successful in further reducing cervical cancer incidence and mortality in the United States (US preventive services task force, 2012).

In Britain, cervical cancer screening started in the mid-1960s. Although many women were having regular smear tests, there was concern that those women at greatest risk were not being tested, and that those who had positive results were not being followed up and treated effectively. Because of these reasons the National Health Service (NHS) Cervical Screening Programme was set up in 1988 when the Department of Health instructed all health authorities to introduce computerized call-recall systems and to meet certain quality standards. This programme has invited about 4.5 million women for screening in 2010/11 and 3.4 million women screened in 2010/11 in England (Office for National Statistics. Cancer survival in England: 2011). Invitation by the woman is done by the NHS call and recall system which invites women who are registered with a general practitioners (GP). It also keeps track of any follow-up investigation and recalls the woman for screening in three or five years ‘time if there is no abnormality. Within the NHS Cervical Screening Programme women should receive their first invitation for routine screening at age 25 as it is national policy. This has reduced health care costs for NHS in UK in consideration of tight government budgets (cancer screening center, 2012).

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In Nigeria, the national incidence of cervical cancer is 250/100,000 (Adewole et al., 1997). Oguntayo et al., (2011) reported that cervical cancer was the leading cause of gynecological cancers in Northern Nigeria, accounting for 65.7% of all gynecological cancers. This high incidence was also observed in Ibadan and Maiduguri (Nigeria) with 62.7% and 72.6% respectively (Pindiga et al., 1999; Adelusi,1978; Rafindadi et al., 1999). While awareness of cervical cancer remains low in Nigeria and mortality figures are among the highest in the world, there are many signs that positive changes are afoot. Several successful pilot schemes, funded by Non-Government Organizations (NGOs) and private enterprises are currently underway for cervical cancer prevention and treatment (Goldie SJ, et al. 2005).

Cervical cancer is the second most frequent cancer among women and the leading cause of cancer deaths in women of reproductive age (WRA). Currently, the estimated annual number of cervical cancer cases is 2454 while the annual number of deaths due to cervical cancer is 1676 in Nigeria. It is projected that by the year 2025, the number of new cervical cancer cases annually in Nigeria will reach 4261. Data from hospital-based registries in Nigeria indicated that cancer of the cervix accounted for 70-80% of all cancers of the genital tract and 8-20% of all cancer cases for the 10-year period of 1981 to 1990. It has been reported that there are 10 to 15 new cases of cervical cancer in Ekiti each week. (Nigeria Cancer Registry, 2012) Despite the magnitude of the problem in Nigeria and the fact that it is easily preventable, the cervical cancer screening coverage in Nigeria for all women 18 to 69 years of age is only 3.2% (National Cervical Cancer Prevention Program, 2012).

Cervical cancer screening methods available in Nigeria, which were part of the Ministry of Health‘s National Cervical Cancer Prevention Strategic Plan from 2002 to 2006, include the Papanicolaou (Pap) test, visual inspection with acetic acid, and visual inspection with Lugol iodine; however, acceptability of these methods remains very low and haphazard. A previous study on Knowledge, Attitude and Practices (KAP) carried out in Nigeriatta National Hospital revealed a past Pap smear screening rate of 22%, while in a different study performed in Voluntary Testing and Counseling (VCT) centers in Ekiti, Nigeria, an acceptability rate of 14% was described. These demonstrate a relatively low level of acceptability of cervical screening. To reach these other women as well, the government of Nigeria has integrated cervical cancer screening into the routine services that the majority of women are exposed to. These routine services are offered at MCH clinics. Although about 300 sites provide screening services, only about 30 (10%) have outpatient treatment services (National Cervical Cancer prevention, 2012).

In Vihiga County, accurate statistics about the number of women diagnosed with and dying from cervical cancer are unknown due to the failure to maintain the pathology-based cancer registry. Most of the research done on cervical cancer screening is carried out in National referral hospitals and the hence minimal researched data on county hospitals. Cervical cancer screening 2013 and 2014 were 7.9% and 5.9% respectively in Vihiga County Hospital (DHIS 2014). The Nigeria National Cervical Cancer Prevention Program- a Ministry of Health initiative focus on achieving at least 70% coverage of women in the age group with the highest risk-benefit ratio; involving communities to build awareness and support; using low cost screening and treatment approaches for pre-cancer; and assuring appropriate management to overt cervical cancer patients within available resources. Vihiga County is way below in achieving this target. However ,this reports and statistics provide a perfect ground for carrying out research on factors influencing acceptability of screening cervical cancer.

Statement of research problem

Cervical cancer is the leading cause of death from cancer among childbearing women (WHO, 2007). Though it is preventable, screening practice of both health workers and clients is limited and little documentation is available. Women, particularly students have been informed on the issue of cervical cancer in many occasions and ways of preventing the disease; however, their knowledge, attitude and practices have been not established (Mmiro et al, 2006). It is important to describe the differences among students and their perceived risk of cervical cancer to determine target groups to increase cervical cancer screening (Sudenga et al 2013).

Cervical cancer kills 270,000 women each year mainly in developing countries, and in the prime of their productive lives, yet cervical cancer is preventable by screening asymptomatic women for precancerous lesion and treating the lesion before it progresses to invasive disease. Studies suggest that if a woman were screened for cervical cancer between the ages of 30 and 40 her risk of cancer will reduce by 25-36%. Students are looked at as the leaders of tomorrow, therefore, their knowledge, attitude and practice to this issue may positively or negatively influence the family and the society at large. It is therefore important to know whether the knowledge and acceptability is associated with or determined by certain demographic factors.

Purpose of the study

The purpose of this study will be to investigate the knowledge and acceptability of cervical cancer screening among female students in Federal Polytechnic Ado.

Objective of the study

General Aim

To assess the general knowledge, and acceptability of cervical cancer screening among female students in Federal Polytechnic Ado.

Specific Objectives

To assess the level of knowledge of cervical cancer and cervical cancer screen among female students.
To determine the attitude of female students towards cervical cancer
To determine the acceptability of cervical cancer screening among female students.

Research questions

The research questions used in addressing the objectives were;

What is the level of knowledge of cervical cancer and screening among female students?
What is their attitude towards cervical screening?
What is their level of acceptability of cervical cancer screening?

Significance of the study

This research will be significant to the health care industry, other researchers and public at large. First, the health care industry, more so Ekiti General Hospital, will benefit from the findings of this study by using it to lay strategies to position itself as a leading health care facility in provision of screening and treating cervical cancer in the state. Secondly, other researchers and academicians, it is hoped, will benefit by using the findings of this study for training and further research, as the study would lay the platform on which further research on the topic can be undertaken. The finding of this will be built on scholarly work done on cervical cancer and screening among women of reproductive age. Lastly, it is hoped that the general public especially women would benefit through embracing screening cervical cancer.

Scope of the study

This study will focus on the knowledge and acceptability of cervical cancer screening among female students in Federal Polytechnic Ado, because of the researcher ‘s familiarity with the screening service and the proposed locality. Further, the researcher has worthy contacts and good working relationships with Ekiti State Hospital staff and clients with hope they’ll fully cooperate.

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