Introduction
Cervical cancer is one of the most common international malignancy in women and a serious public health problem. The main burden of cervical cancer actually is in the developing country, as it takes away young mothers causing considerable emotional and economic upset in the family.1 In the world , the annual incidence is approximately around five lakhs women, and nearly 274000 of them are already dead by getting affected in the disease process. 1 Cancer cervix is the most common cancer or malignancy among Indian population(female) and approximately one fifth to one sixth cases of cancer cervix world wide occur in India. 2, 3 The most common symptom of cervical cancer is abnormal vaginal bleeding. In India, 23.3% of all cancer deaths are due to cervical cancer.4 The primary underlying cause of carcinoma cervix is human papilloma virus also known as HPV, which is one of the sexually transmitted diseases. 5 HPV infection leads to pre-cancerous changes in the cervical epithelium called as cervical intra-epithelial neoplasia (CIN), which has the potential to turn into cancer or malignancy if left untreated. 6 It is important to find out the willingness of women to utilize screening services and to comply with the follow up treatment protocols. Global evidence demonstrates that the key to reducing cervical cancer cancerous lesions.7 Population-based screening program utilizes exfoliative cervical cytology,8 the papanicolaou (Pap) smear decreases the cervical cancer morbidity and mortality in developed countries. 9, 10 Population‑based screening with Pap smear is an important secondary preventive measure for cervical cancer that leads to a high‑cure rate among cervical cancer patients. Pap smear has been responsible for a 90% decrease in the number of deaths due to cervical cancers in the United States.11
Materials and Methods
A community based cross sectional study was held from January to May 2017 among inhabitants of a semi urban township in eastern India. Those female aged between 30 years to 60 years. Total two thirty six participants were randomly selected. They were informed about the nature of this study with full confidentiality in their own local language. The questionnaires were created based on risk factors, causes or etiologic factor, signs and symptoms, diagnosis, also prevention of the malignancy. The question forms were distributed at the public gatherings like market places, temples, parks, and residential apartments. This questionnaire consisted few questions about cervical cancer with additional questions like age, educational level, sexual exposure and employment status for demographic recordings. Each of the question had responses like “yes” and “no”.
Statistical analysis
The data was first entered in MS-Excel and then it was filtered and cleaned. The filtered data was then entered in SPSS v. 20 and the data analysis was done using the same. The confidence interval was determined at 95% C.I. (p= 0.05).
Chi- square test was used to see whether distributions of categoricalvariablesdiffer from each another.
The formula for the chi-square statistic used in the chi square test is:
Where O is the observed variable and E is the expected variable
To find the co-relation between the effects of variables on eachother. A correlation coefficient of 1 means that for every positive increase in one variable, there is a positive increase of a fixed proportion in the other.
A correlation coefficient of -1 means that for every positive increase in one variable, there is a negative decrease of a fixed proportion in the other.
Zero means that for every increase, there isn’t a positive or negative increase. The two just aren’t related.
It is calculated by the formula:
One of the most commonly used formulas in stats is Pearson’s correlation coefficient formula. If you’re taking a basic stats class, this is the one you’ll probably use:
Where X and y are the two different variables for which the correlation testing is carried out. In the table 3, the stage or the grading of carcinoma is directly proportional to the number of nodes identified and total number of positive nodes. Thus, when there is more number of positive nodes and there is more number of nodes identified, this increases in the stage of cancer.
Results
Physiognomies of the study inhabitants (Table 1)
A total of two thirty six females were included in the study. Majority of females that is ninety one females (n-91) being in the age group of 41- 50 years, which comprises 38.55 percentage. 35.17 percentage (n=83) study population were illiterate. 66.95 percentage were sexually active. 63.30 percentage (n=100; out of 158 females those of who are sexually active) were using contraceptive methods. The proportion of females who were aware of cancer cervix increased with the literacy level, and this association was statistically significant and proved. The awareness about the cervical cancer was more in the age group of 30-40 years among the females. Those who use contraception were more knowledgeable about cervical cancer than those who do not use contraception or sexually not active.
Knowledge of the risk factors of the cancer (Table 2)
The females who were aware or unaware about the cancer or malignancy were asked about the causative factor of the particular deadly cancer. Maximum of women that is 25.84 percentage (n- 61) mentioned unhygienic state of the vaginal area as an important risk or causative factor. Less or least number that is only six number of female found human papilloma virus infection of the lower genital tract that includes vagina as well as cervix is the risk factor for the malignancy. Similarly, those women using contraception were more knowledgeable than other category.
Response about sign and symptoms (Table 3 )
Out of two thirty six females all, who were aware or not aware about the malignancy were asked about the signs and symptoms of the particular cancer or malignancy. The results are described subsequently. Fifty two females (that is 22.03 percentage) were aware of the bleeding after intercourse is a sign of the particular malignancy. After that fifty one females that is 21.61 percentage were aware of local signs and symptoms like itching, redness, and fowl smelling, also the same percentage of the females were aware of post-menopausal bleeding as a symptom of the malignancy. In the declining order pelvic pain (n=46) and vaginal discharge (n=36) were the sign and symptoms known by the females respectively.
Awareness of cervical malignancy and screening (Table 4)
The proportion of the females who were aware of the cancer cervix increased with the literacy status level of them, and this association was statistically significant. The awareness about the cervical cancer was more in the age group of 30-40 years among the females. Those who use contraception were more knowledgeable about cervical cancer than those who do not use contraception or sexually not active.
Table 1
Demographic characteristics
Table 2
Responses of risk factors
Table 3
Responses about sign and symptoms:
Table 4
Practice: screening and prevention of cervical cancer
Discussion
Cervical cancer is a preventable disease if diagnosed early. The important factor for early detection is screening properly. The achievement of any screening programme will depends upon proper and active services, dedication of the health professionals, easy accessibility, little price, and above all the awareness and attitude of the female at the receiving end. 12 The mean age of the participants in our study was 78.66 years. This was not exactly comparable to another study from Saudi Arabia 13 in which the mean age was 42 years. A study from Puducherry, 14 India also reported a mean age of 40 years among the study samples. In a study from the country Nepal, 15 the mean age of the study sample or participants was 29.9 years, which is not concordance with our study. The current study inhabitants had very poor knowledge about established risk factors of the carcinoma of cervix which is consistent with the findings in a study was done in India. 14, 15 In our current study on the etiology of the cancer cervix awareness was low, hence this indicated that these women had low awareness on human papilloma virus infection and cervix cancer correlation. Similar result also found in Seng, et al study. Smoking and tobacco consumption is one more explanation for cervical cancer; smokers have an excess risk of cervical cancer. within the present study, these women are still lack of awareness on this aspect. Again the study is in concordance with Seng et al. 16 The cervix cancer is predicted to decreased by 2020, and there are many factors donating to its decline. The advance within the living standard and awareness among women through print and audio-visual media has resulted in a very decline within the incidence of cervical cancer. Regular cervical cytological examination by all sexually active women can prevent the occurrence of carcinoma cervix. 7 additionally, awareness for female genital hygiene and visiting hospital at pre-clinical stage are the contributory factors for the control of carcinoma cervix in urban settings. Things of cancer prevalence is alarming in rural population where the majorities of ladies are illiterate and are ignorant about the factors that contribute to the event of cervical cancer. they're socio-economically weak and have poor hygienic conditions and plenty of other risk factors like early age marriage and multiple pregnancy. additionally, medical facilities, advice and awareness programmes are almost non-existent. 17, 18 Sexually transmitted disease is really proven to be one among the causes.19 During this study, it implies that ladies in Malaysia may have some extent of awareness on this aspect. Quite ninety percentage school going adolescent girls ages between thirteen to twenty years old usually have better awareness on HIV and AIDS, but low awareness on human papilloma virus infection. People are alert on sexually transmitted disease as an key element for cancer cervix, but not all sexually transmitted diseases are known by them. 20 Early sexual exposure is thought to have correlation with cancer cervix. Associated factors with cervical cancer includes a strong history of multiple sexual partners and sexual exposure before seventeen years of age. Women with none exposure to sexual activity have low risk for the cancer.21 Early sexual exposure is recognised to be a risk factor upto 44.3 percentage. 22 Unfortunately, in our current study women’s awareness on this aspect is yet to be strengthened. Prophylactic oral contraceptive pills are the contributing factor for the cervix cancer. Women taking oral contraceptive pills with a minimum of five years are subjected to a two fold risks of developing the cancer. 23 Studies showed the information that have demonstrated the data about cancer cervix appears to be a crucial factor to see women’s willingness to participate in cervical cancer screening programme. 24, 25, 26 our present study showed that the training of papanicoulao smear screening was very less Our study showed that the training of smear screening was very less but the boldness of our participants toward screening was quite good. Hence, health programs to boost the notice of ladies can help during a good way to cut back the frequency of cervical cancer.
Conclusion
There is also need for educational involvements and mindfulness programmes not only to augment about the human papilloma virus immunization but also screening for the cervical cancer to control or seize the progression of the disease. Primary prevention is best method to adopt for the developing countries like India. For a mass human papilloma virus vaccination in India affordability, openness, education about the same and convenience is needed. For numerous issues exact to the region, a gainful second-generation vaccine is the essential of the period. Hence, routine cytological screening should be continued to be used to detect and treat women who are infected before vaccination or with other human papilloma virus types not covered by the vaccine.
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