Cervical Cancer Screening Among Female Part-Time Students Essay

Cancer of the cervix remains the most common malignant neoplasm of the female genitalia and the second most common cancer in women.. Cervical Cancers screening serves to detect the possibility that a cancer is present. The main objective of the study was to determine the knowledge and acceptability of Cervicals Cancer Screening among Female Part- Time Students in University of Benin. The hypothesis for the study was: there is no relationship between knowledge of cervical cancer and acceptability of cervical cancer screening. Survey research design was used in the study. Simple random sampling was used to select the sample. The sample consisted of 200 Female Part- Time Students in University of Benin.

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Data was collected using questionnaire. Cervical Cancer Screening Among Female Part-Time Students Essay The study findings revealed that slightly above half more than half of (74%) of the respondents were between the age of 20-25 years, 58 (77%) respondents could not remember age of their first sexual intercourse, the majority 168(86%) of respondents have heard of cervical cancer, majority 126 (63%) of respondents heard about cervical cancer from media, hundred and two (51%) participants explained cervical cancer as abnormal lesion on the cervix, sixty four (32%) respondents stated that unprotected sexual intercourse is a risk factor of cervicals cancer, sixty (30%) of respondents stated that abnormal vaginal bleeding is a sign of cervical cancer, 120 (60%) respondents stated that cervical cancer can be detected by cervicals cancer screening, majority 194 (97%) of respondents stated that cervical cancers screening is done in hospital, majority 178 (89%) of respondents had never been screened for cervical cancers, majority 94 (47%) of respondents strongly agreed that cervical cancer screening is important, the majority 144(72%) of the respondents had no intention of going for cervicals cancer screening, majority 80 (40%) of respondents stated that lack of awareness to cervical cancers screening is a major barrier to cervical cancer screening. The study recommends among others that nurses should engage more on giving Information Education and Communication (IEC) at all levels of Health Care Delivery toward cervical cancers screening. Cervical cancers screening center should be made available in university of Benin health center at subsidized amount so that female students can easily access the service.Cervical Cancer Screening Among Female Part-Time Students Essay

CHAPTER ONE

INTRODUCTION

BACKGROUND OF STUDY

Cervical cancer is the most common malignancies among females worldwide especially in women of 20–39 years of age. Its contribution to cancer burden is significant across all cultures and economies. Cervical cancer also accounts for over 270,000 deaths worldwide, an overwhelming majority of which occur in the less developed regions (Imam, 2008). Globally there are over 500,000 new cases of cervical cancer annually and in excess of 270,000 deaths, accounting for 9% of female cancer deaths. 85% of cases occur in developing countries and in Africa (Campbell, 2008). Cervical cancer remained the second leading cause of cancer deaths after breast cancer and the fifth most deadly cancer in women, accounting for approximately 10% of cancer deaths (Okonofua, 2007). The developing countries have carried a disproportionate share of the burden and 80 % of the 250,000 cervical cancer deaths in 2005 occurred there (WHO, 2007; Uysal & Birsel, 2009). Cervical cancer is the malignant cancer of cervix uteri or cervical area. This happens when normal cells in the cervix change into cancer cells (Arbyn, 2005).Cervical Cancer Screening Among Female Part-Time Students Essay

Cervical cancer is the fourth most common malignancy affecting women worldwide, accounting for nearly 10% of all cancers (excluding non-melanoma skin cancers) and about 265,700 deaths annually (7.5% of all female cancer deaths) (1). This burden of disease exists in spite of cervical cancer being one of the most preventable cancers (2).
The causal association between cervical cancer and Human Papilloma Virus (HPV) is one that is well established (3)(4)(5). Thus, prevention strategies are largely targeted at preventing HPV infection or preventing disease progression for those who are infected. There are 2 types of preventive measures available to reduce incidence and mortality from cervical cancer: i.) Vaccination and ii.) Screening. While vaccination is a primary preventive measure (providing protection against the incidence of illness), screening is a secondary preventive measure aiming to diagnose illness early and prevent its progression. Combining screening and vaccination against HPV should potentially provide the best protection against cervical cancer as neither option alone offers 100% protection. At present, screening strategies for cervical cancer have not been altered for females who are HPV vaccinated (6). Screening vaccinated women is arguably still a requirement because of the limitations of current HPV vaccines both in their lack of therapeutic effect (not protecting women with ongoing neoplastic processes) and in their coverage of limited number of HPV types (leaving to evolve some 25–30% of cervical cancer cases related to HPV types other than 16 or 18 strains). Consequently, for health economists, the question regarding the most cost-effective combination of screening strategies along with vaccination arises. The economic impact of screening HPV vaccinated populations is analytical information that health policy makers require for the formulation of effective, evidence-based strategies.Cervical Cancer Screening Among Female Part-Time Students Essay

The purpose of this literature review is to collect and collate the best possible evidence available to answer this question. This review aims to systematically analyze health economic studies on HPV vaccination to provide integrated evidence and recommendations based on its cost–effectiveness when combined with differing cervical cancer screening strategies.

CAVEAT:

Prior Knowledge:

During the search conducted in July 2017, it was noted that a systematic review by Mendes et al (7) on CEA of prevention strategy combinations against HPV infection, was published on March 28th 2017 (after the preliminary literature review search was conducted by the author). Upon examining this paper, it was found that:

i) No quality appraisal of the papers included in the review was carried out.

ii) No papers analyzing the cost effectiveness of screening strategies in populations vaccinated with the non-avalent (9-valent) vaccine (8) were included

iii) The search was finalized in April 2014 resulting in the exclusion of all papers since 2014 till July 2017 Cervical Cancer Screening Among Female Part-Time Students Essay

iv) The study focused only on studies based in Austria, Belgium, Switzerland, Czech Republic, Germany, Denmark, Spain, Finland, France, Greece, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Sweden, Slovenia, and the UK, the US, Canada and Australia excluding relevant studies from other parts of the world

Contribution from this literature review:

i) Complete appraisal of all papers using the recommended CHEERS checklist for economic evaluations (9)

ii) A crucial CEA conducted on screening strategies within cohorts vaccinated with the nonavalent or 9-valent vaccine (10)

iii) Studies published after April 2014 were added to this literature review (8) (10)(11)

iv) Relevant studies carried out in Africa (12), Thailand (13), Laos (14), China (15), Taiwan (16) , Israel (17) have been included and reviewed

HPV and Cervical Cancer:

HPV (Human Papilloma Virus) is currently the most common sexually transmitted virus (3). It is passed on primarily through genital contact (such as vaginal and anal sex) and also by skin-to-skin contact (3). Over 100 types of HPV have been identified and more than 40 of these infect the genital area. Although there are several high-risk HPV types, the infection of 2 particular HPV types: 16 and 18 are found to be responsible for 70%–75% of all cervical cancers and 40%–60% of its precursors (18). Among the cancer-related outcomes of HPV infection, cervical cancer is the most important outcome, with over 5,00,000 new cases and 2,75,000 attributable deaths world-wide in 2008 (19). The high-risk (cancer causing) types of HPV include: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 (20). Women who are infected with HPV may have their infection clear, progress or persist. Persistence is the most significant determinant of whether or not a HPV-infected woman will develop a clinically significant sequelae (4).Cervical Cancer Screening Among Female Part-Time Students Essay

Primary Prevention – Vaccines:

Currently 2 first generation HPV vaccines have enabled prevention against the two most common types of human papillomavirus infection – strains 16, 18 (Bivalent) and also 6 and 11 (Quadrivalent). Clinical trials have provided evidence that the bivalent vaccine was 100% [95% confidential interval (CI) 47–100%, N = 1113] effective against HPV types 16 and 18, and the quadrivalent vaccine 98% [95% CI 86–100%, N = 10,565] (21) (22). These vaccines, have been made available in several countries since their international approval and we are now in the phase of possibly of utilising the second generation of ‘non-avalent’ HPV vaccines (23). These newer vaccines have potential for protection against persistent infection from HPV types 6/11/16/18/31/33/45/52/58 (which together cause ~90% of cervical cancers, globally) (5).

Secondary Prevention – Cervical Cancer Screening Tools:

Persistent HPV infection can cause pre-cancerous cervical lesions and invasive cervical cancer thereafter. With regular cervical cancer screening and appropriate follow-up, most cervical cancer precursors can be identified and treated, interrupting progression to the severe disease stage. Screening programs can reduce cancer risk among those who do not receive the vaccine, those infected by non-vaccine targeted HPV types, and those who demonstrate reduced vaccine efficacy, providing insurance at the population level, given the uncertainties surrounding vaccine performance. The screening tools available include (24):Cervical Cancer Screening Among Female Part-Time Students Essay

a.) Cervical Cytology:

Evidence suggests that cervical cancer screening using cytology is one of the most successful public health prevention programs, particularly when implemented in a mass strategy (25). This method involves the collection of exfoliated cells from the cervix followed by microscopic examination of the same after staining, for cellular abnormalities. Based on these abnormalities, further investigation is required to arrive at a diagnosis. There are two cytological screening methods:

i) Conventional PAP smear

ii) Liquid Based Cytology (LBC)

These 2 methods have been extensively compared and it is found that LBC is significantly advantageous in terms of sensitivity and possibility for ‘reflex testing’ of HPV infection without new sample requirements. (26)(27)(28)Cervical Cancer Screening Among Female Part-Time Students Essay

b.) Visual Inspection:

Visual inspection of the cervix continues to be implemented as a screening tool for low-resource settings, despite its limited specificity and poor positive predictive value (PPV), as it is economical and can provide immediate results. This metho
d involves direct visual examination for abnormalities or lesions in the cervix after staining with acetic acid or Lugol’s iodine referred to as Visual Inspection with Acetic Acid (VIA) or Visual Inspection with Lugol’s Iodine (VILI), respectively. (29)

c.) HPV DNA Testing:

Similar to Cytology, HPV DNA testing is done on sample cells collected from the cervix and is used to confirm the presence of infection by the HPV Virus (3)(25). This test has shown higher sensitivity and reproducibility of results than Cytology, for detecting high-grade cervical intraepithelial neoplasia (CIN), (although lower specificity) (30)(31). Unfortunately, the high cost of this option has limited its availability in Low and Middle income countries of the world (32).

Economic Evaluation:

With the costs of healthcare increasing worldwide, there is advancing pressure to ration and efficiently use limited resources. Economic evaluations are utilized to identify, measure, and compare health care intervention costs and benefits, to aid in efficient resource allocation (33).

Economic evaluation, as per the Drummond et. al definition, refers to “the comparative analysis of alternative courses of action in terms of both their costs and consequences” (34). The basic types of economic evaluation include:Cervical Cancer Screening Among Female Part-Time Students Essay

1. Cost-benefit analysis (CBA):

CBA measures the benefits and costs of outcomes achieved from an intervention in purely monetary terms. This means that expected years of life gained or expected improvements in health and wellbeing are valued in terms of currency. There is much controversy surrounding CBAs on account of ethical and practical reliability questions on how one may accurately express health outcomes in monetary terms.

2. Cost-effectiveness analysis (CEA):

To overcome the limitations of CBA, CEA was developed as an alternative, more practical approach to healthcare decision-making. It assesses the net cost of a project or service relative to the outcomes generated. CEA is used where the need for a project has already been established, but uncertainty remains over the best method for achieving it (35). The purpose of cost effectiveness analysis is to identify the best method to spend a set budget to achieve a particular goal (36).Cervical Cancer Screening Among Female Part-Time Students Essay

3. Cost-utility analysis (CUA):

CUA is often seen as a special form of CEA that introduces measures of benefits that reflect individuals’ preferences over the health consequences of alternative programs that affect them. CUAs use a global measure of health outcome, such as quality-adjusted life-years (QALYs) by undertaking one program instead of another, and the results are often expressed as a cost per QALY gained. (37) This enables the comparison of different types of programs, which makes CUA more practical for decision-makers.

4. Cost-Minimization Analysis (CMA):

Sometimes a cost-minimization analysis is performed if the alternatives under evaluation are considered to achieve the identical health outcomes and carried out in terms of net cost comparisons (38). This specificity of outcome measure reduces its application across health fields, thereby limiting its utilization in evaluation studies.

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Source:https://www.ispor.org/PEguidelines/source/Guidelines_Austria.pdf

Economic Modelling:Cervical Cancer Screening Among Female Part-Time Students Essay

Full economic analyses of interventions can be carried out by the following approaches:

1. Trial-based studies:

As randomized clinical trials are a necessary condition for the successful licensing of pharmaceuticals, relevant economic data are often obtained alongside the trials for economic evaluations. This method provides internal validity, while the main limitation is that the results may suffer from external generalizability (39).

2. Decision analytic modeling:

This approach brings together a range of evidence sources and allows the expansion of the comparators considered in the analysis and an expansion of the time horizon beyond that of a trial period. Further, decision analytic modeling provides a framework for informing specific decision-making under conditions of uncertainty by allowing more convenient assessment of modeling assumptions, modeling structural uncertainty, and different patient subgroups (heterogeneity) (37). Important model types include:Cervical Cancer Screening Among Female Part-Time Students Essay

i) Decision Trees: This is the simplest form of decision analytical modelling in economic evaluation. The pathways in decision trees follow each intervention or process option in a series of logically ordered alternative events, denoted by branches emanating from chance nodes (circular symbols). The alternatives at each chance node must be mutually exclusive and their probabilities sum exactly to one. The end points of each pathway, denoted by terminal nodes (triangular symbols), are assigned values or pay-offs, such as costs, life years, or quality adjusted life years (QALYs). Once the probabilities and pay-offs have been entered, the decision tree is “averaged out” and “folded back” (or rolled back), allowing the expected values of each option to be calculated.

ii) Markov Model: An alternate form of modelling is the Markov model. Unlike decision trees, which represent sequences of events as a large number of complex pathways, Markov models involve simpler and more flexible sequencing of outcomes, including recurring outcomes, through time. Patients are assumed to reside in one of a finite number of health states at any point in time and make transitions between those health states over a series of discrete time intervals or cycles. The probability of staying in a state or moving to another one in each cycle is determined by a set of defined transition probabilities. The definition and number of health states and the duration of the cycles will be governed by the decision problem (40). The final stage is to assign values to each health state, typically costs and health utilities (41)(40). Most commonly, such models simulate the transition of a hypothetical cohort of individuals through the Markov model over time, allowing the analyst to estimate expected costs and outcomes. This simply involves, for each cycle, summing costs and outcomes across health states, weighted by the proportion of the cohort expected to be in each state, and then summing across cycles (42). If the time horizon of the model is over one year, discounting (34) is usually applied to generate the present values of expected costs and outcomes.Cervical Cancer Screening Among Female Part-Time Students Essay

iii) Microsimulation models: These models simulate the progression of individuals rather than hypothetical cohorts. They track the progression of potentially heterogeneous individuals with the accumulating history of each individual determining transitions, costs, and health outcome. Unlike Markov models, they can simulate the time to next event rather than requiring equal length cycles and can also simulate multiple events occurring in parallel.

iv) Discrete event simulations: They describe the progress of individuals through healthcare processes or systems, affecting their characteristics and outcomes over unrestricted time periods. These simulations are not restricted to the use of equal time periods or the Markovian assumption and, unlike patient level simulation models, allow individuals to interact with each other.Cervical Cancer Screening Among Female Part-Time Students Essay

v) Dynamic models: These models allow internal feedback loops and time delays that affect the behaviour of the entire health system or population being studied. They are particularly valuable in studies of infectious diseases, where analysts may need to account for the evolving effects of factors such as herd im
munity on the likelihood of infection over time, and their results can differ substantially from those obtained from static models.

Economic Evaluation Outcomes and Decision rule:

The results of an economic evaluation of an intervention are typically expressed in terms of an ICER – Incremental Cost Effectiveness Ratio. ICERs (measured most often in cost per QALY gained) reflect the incremental cost required to sustain one unit of benefit gained from a particular intervention compared to another. It applies to a decision rule based on a threshold cost effectiveness ratio. This decision rule states that any intervention with a price per unit effectiveness above a fixed threshold, would not be implemented and any program with an ICER below the threshold would be implemented. The threshold that this decision rule is applied to differs between economic settings. The threshold recommended by WHO involves utilizing a value which is a multiple of the GDP of the country under study (43) for cost effectiveness acceptability. An alternative to this is to cite the cost–effectiveness of an intervention that has previously been implemented in the country under study and to utilize the same as a benchmark for acceptable cost–effectiveness. The latter, however, is an approach used mainly in High income countries(43).Cervical Cancer Screening Among Female Part-Time Students Essay

AIMS:

The aim of this systematic literature review is to present the comprehensive results of all available international evidence on the cost-effectiveness analysis of different cervical screening strategies for HPV vaccinated populations.

OBJECTIVES:

The main objectives of this review are to:

1) Identify studies conducted to examine cost effectiveness of screening carried out for women post-HPV vaccination.

2) Examine and compare cost effectiveness outcomes of different screening strategies based on frequency, tools implemented and age of primary screening.

3) Conduct a critical appraisal of the literature included for the review.

4) Provide an assessment of the reporting quality of the literature included for the review.Cervical Cancer Screening Among Female Part-Time Students Essay

METHODOLOGY:

Ethical Approval:

Ethics approval was first applied for on 31st March 2017 after an initial literature search was conducted to confirm that there were no existing systematic reviews on the topic. Approval was granted by the London School of Hygiene & Tropical Medicine MSc. Research Ethics Committee, on 10th April 2017 (Ethics Ref: 13528 /RR/7584).

PICO Framework:

The P.I.C.O. framework was implemented for the formulation of the appropriate researchable question (44):

Population (P): HPV Vaccinated women

Intervention (I): Screening or vaccination or none

Comparators (C): Comparator screening strategy

Outcome (O): Incremental Cost Effectiveness Ratio

Based on the PICO framework for the research topic, the literature review was then carried out following the PRISMA flowchart in phases of Identification, Screening, Eligibility and Inclusion (45)Cervical Cancer Screening Among Female Part-Time Students Essay

Search Strategy:

A comprehensive literature search of peer-reviewed, published journal articles in English was carried out in the standard online databases EMBASE, MEDLINE, PUBMED, NHS EED and Cochrane Library. (NHS EED was not a separate search as it is covered through the Cochrane database (46)). The search strategy was designed using appropriate MeSH and Text words to cover synonyms, combinations and word choices with the main categories which included: 1) Cost effectiveness 2) Screening and 3) HPV Vaccination. This strategy was developed with the help of expert advice from the librarians at the London School of Hygiene & Tropical Medicine. The strategy used for the key words were based on an exploded list of associated MeSH words (identified on PubMed) and free text words, as below:

i. Screening: “Early Diagnosis”, “Early Detection of cancer”, “Screening”,

ii. HPV vaccination: “Papillomavirus Vaccine” “Human Papillomatous Vaccine”, “HPV Vaccine” and “HPV Vaccination”

iii. Cost-effectiveness: “cost effective*” “cost-effective*” “costeffective*” “cost-benefit analysis”, “costbenefit analysis”, “cost benefit analysis”, “cost”, “economic”, “benefit”, “effectiveness”, “Incremental cost-effectiveness analysis”, “Incremental cost-effectiveness ratio”, “ICER”.Cervical Cancer Screening Among Female Part-Time Students Essay

Boolean commands of “OR” and “AND” were used appropriately, to join synonyms and string the key words together, respectively (47). The bibliographies of selected publications were scanned and titles cross-referenced to ensure relevant studies were not missed out in the database search.

Study Selection:

All titles of the papers identified were reviewed to filter those which were obviously irrelevant. Following this, the titles and abstracts of remaining papers were reviewed and duplicates were removed. Applying exclusion and inclusion criteria (agreed upon by the author and supervisor) papers with content relevant to the research topic were then isolated. Finally, the citations within these papers were screened thoroughly using the same inclusion criteria to ensure all relevant articles were included for review. The final list of papers identified was then examined in full text, for the data extraction process. The search was completed in July 2017.

Inclusion Criteria:

1. Primary economic evaluations which satisfy the Drummond et al. definition of CEA “the comparative analysis of alternative courses of action in terms of both their costs and consequences”

2. Cost effectiveness analysis (CEA) of different screening strategies combined with HPV vaccination Cervical Cancer Screening Among Female Part-Time Students Essay

3. Cost effectiveness analysis with outcome parameters expressed in terms of Incremental Cost Effectiveness Ratio (ICER)

4. Articles in the English language available in full text

Exclusion Criteria:

1. Partial economic analyses (studies that consider either costs or consequences but not both) were not included

2. CEAs of cervical screening between vaccinated and unvaccinated cohorts with no explicit analysis of different screening methods within the vaccinated cohort and only minor variations in the sensitivity analysis were not included.

3. CEAs comparing the same screening strategies combined with different HPV vaccine types, schedules and doses were not included

4. Economic analyses which do not provide outcomes in terms of ICERs were not included

DATA EXTRACTION:

Subsequent to literature identification and screening, the data extraction was conducted by filling in an excel sheet with pre-determined fields which included : Authors’ names, Year of research, Geographical context, Aim, Model implemented, Economic perspective, Vaccine parameters (type, effect duration, dose/ schedule and cost), Screening parameters (tool combinations, frequency and starting age), WTP threshold, Time Horizon, Outcome parameter, Base case results, DSA/ PSA results, Scenario analysis results. Data regarding cost effectiveness of interventions analysing vaccination alone or screening alone was not extracted as it was irrelevant to the research question for this review.Cervical Cancer Screening Among Female Part-Time Students Essay

ANALYSIS:

The data extracted was analysed and a narrative description based on their reporting quality, methods and results, grouping them into categories was undertaken.

Quality appraisal:

A quality analysis on reporting of economic evaluations was carried using the recommended CHEERS (Consolidated Health Economic Evaluating Reporting Standards) checklist (9) consisting of 24 items. This checklist was employed because it provides the most relevant criteria for assessing economic evaluations (9) under the subsections of Title and Abstract, Introduction, Methodology, Results and Discussion. The papers were appraised using the checklist version created in Excel and completed in August 2017. Details of the appraisal conducted are attached in the Appendix (Ref. Table No. 2)

Analytical categories:

Owing to high levels of heterogeneity between papers in terms of screening strategy comparisons, modelling methods chosen and geographical context, a descriptive analysis was undertaken. By studying the data extraction tables, papers were then grouped together based on the following broad categories to highlight differences and similarities within these subgroups:Cervical Cancer Screening Among Female Part-Time Students Essay

1) ECONOMIC SETTING

2) METHODOLOGICAL APPROACHES

1. Economic perspectives

2. Economic models implemented

3. Outcome measures

4. Cost Effectiveness Thresholds

3) POLICY FINDINGS

1. Screening tool comparisons

2. Screening frequency comparisons

3. Comparisons of varying age of first screening

4. Screening strategies in the context of the nonavalent vaccine

Human Papilloma Virus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer. Sexually transmitted human papilloma virus infection leads to the development of cervical intraepithelial neoplasia and cervical cancer (Colgan, 2006). HPV is spread through sexual contact and although most women’s bodies can fight the infection, sometimes the virus leads to the development of cervical cancer. HPV types 16 and 18 cause 70% of cervical cancer cases, whereas types 6 and 11 cause 90% of genital warts cases. During persistent HPV infection, precancerous changes may be detected in the cervix, that is, readily detectable changes occur in the cells lining the surface of the cervix, therefore early detection and treatment of these changes is an effective strategy for the prevention of cervical cancer and forms the basis of cervical screening programmes (Stephen, 2006). Women with many sexual partners, and those whose partners have had many sexual consorts, or have been previously exposed to the virus, are most at risk of developing the disease (WHO, 2007).Cervical Cancer Screening Among Female Part-Time Students Essay

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In developed countries of Europe and America that have organized national cervical screening programs, early detection and treatment of precancerous cervical lesions have resulted in a dramatic reduction in the incidence of and mortality from cervical cancer (WHO, 2007). Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can prevent the development of cancer. Cervical cancer is a major risk in women today especially at the age of 20years and above. Awareness of screening programme, preventive vaccination and diet are preventive measures that reduce the incidence of cervical cancer. In developed countries, the widespread use of cervical screening programmes has reduced the incidence of invasive cervical cancer by 50% or more (Population Reference Bureau, 2005).

Cervical cancer is the most common genital tract malignancy of women living in poor rural communities of developing countries (Ferlay, 2006). Such populations lack cervical screening facilities and other basic infrastructural and human resources essential for effective primary healthcare delivery. Symptoms of cervical cancer include; vaginal discharge containing blood, abnormal vaginal bleeding, pelvic pain, blood in urine, bowel symptoms, blood in stool, painful sex, unusual vaginal bleeding, unusual vaginal discharge, contact bleeding, vaginal mass, moderate pain during sexual intercourse, loss of appetite, weight loss, fatigue. Others are loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen leg, heavy bleeding from the vagina and leaking of urine or faeces from the vagina in advanced cases (Duncan, 2005).Cervical Cancer Screening Among Female Part-Time Students Essay

Cervical cancer incidence and mortality rates have declined substantially in Western countries following the introduction of screening programmes. The ideal ages of women for screening are 30– 40 years owing to high risk of precancerous lesions due to being sexually active; and a precancerous lesion is detectable for 10 years or more before a cancer develops (Olamijulo, 2005). Although it has been already proven that the efficiency of regular pap tests reduced the mortality rate of cervical cancer, its application in the developing countries is less compared with the developed countries.

The lack of knowledge concerning cervical cancer may be related to this fact (Yaren, 2008). In developed countries, the widespread use of cervical screening programmes has reduced the incidence of invasive cervical cancer by 50% or more. Cervical cancer is one of the most preventable of all cancers through primary and secondary prevention, prophylactic Human Papilloma virus (HPV) vaccination and cervical screening (Ezem, 2006) Cancer of the cervix remains the most common malignant neoplasm of the female genitalia and the second most common cancer in women (World Health Organization / Institute Catald’ Oncology – WHO/ICO, 2010). It’s the common cause of death among middle aged women, with an estimated 529,409 new cases and 274,883 deaths in 2008 (WHO/ICO,2010).The hardest – hit regions are countries such as Central and Southern America, the Caribbean, Sub Saharan Africa and part of the Oceania and Asia with the highest incidence over 30/100,000 women (Alliance of Cervical Cancer Prevention- ACCP,2005). An estimated 1.4 million women worldwide are living with cervical cancer and 2 to 5 times more up to 7 million worldwide may have precancerous conditions that need to be identified and treated(ACCP,2005). In the United Kingdom (UK), cervical cancer is the second most common cancer among females under 35 years of age accounting for 702 new cases in 2007.According to the UK’ statistics report for 2010, 2,828 new cases were diagnosed in 2007.Cervical Cancer Screening Among Female Part-Time Students Essay

Furthermore, WHO 2008 asserted that cervical cancer remains a major public health problem. The report further indicates that approximately 500 women develop cervical cancer and 274 deaths occur each year from cervical cancer in developing countries (WHO, 2008). More than 80% of the world’s new cases and deaths due to cervical cancer occur in the developing world and less than 5%women in these settings are never screened for cervical cancer even once in their life time (Sanghvi, Lacoste, McCormick, 2005). Possible reasons for a low participation in cervical cancer screening include; ignorance of the existence of such test, ignorance of importance of screening or lack of risk awareness and the risk factors to the development of cervical cancer, absence of symptoms and lack of awareness of centers where such services are obtainable, and lack of motivation to get screened (Aniebue & Aniebue 2010).Cervical Cancer Screening Among Female Part-Time Students Essay

STATEMENT OF THE PROBLEM

The level of awareness and utilization of cervical cytology services among women in the country is unclear as there is no reliable population – based cancer registry or prevention program databases, and very few regional – based studies have been reported in the country. (Gharoro & Ikeanyi, 2006). Cancer prevention program in UBTH has recorded various degrees of successes, and limited to opportunistic screening until the establishment of Centre for Disease Control (CDC) in UBTH in 2006. What has been the norm is that women are screened when they attend for other gynaecological complaints during clinic visits and consultations. (Gharoro & Ikeanyi, 2006). A search of literatures revealed that there are little evidence studies done on knowledge and acceptability of cervical cancer screening in the university of Benin community. One of such studies is the study carried out by Gharoro and Ikeanyi in 2006 on appraisal of the level of awareness and utilization of the pap smear as a cervical cancer screening test among female health workers in University of Benin Teaching Hospital. The study revealed that a large number of the female health workers were aware of the disease, cervical cancer and pap test availability in the hospital, yet, the screening uptake was abysmally poor. Base on this gap in studies done on cervical cancer screening, the situation warrants a detailed study on the knowledge and acceptability of cervical cancer screening among Female Part- Time Students in University of Benin.Cervical Cancer Screening Among Female Part-Time Students Essay

OBJECTIVES OF THE STUDY

Specific objectives

1. To determine the knowledge of cervical cancer screening among Female Part- Time Students in University of Benin.

2. To determine the acceptability of cervical cancer screening among Female Part- Time Students in University of Benin.

3. To identify barriers to cervical cancer screening service.Cervical Cancer Screening Among Female Part-Time Students Essay

SIGNIFICANCE OF THE STUDY

Center for Disease Control (CDC) in University of Benin Teaching Hospital has recorded low utilization of cervical cancer screening service since the inception of the programme; therefore it is important that a study be conducted to determine the knowledge and acceptability of cervical cancer screening in its catchment area. For many years studies on cervical cancer related issues have focused on knowledge, attitude and practice towards cervical cancer. There are little evidence studies done on knowledge and acceptability of cervical cancer screening in University of Benin Community. In view of this gap in studies done on cervical cancer, it is important that the researcher conducts a study to determine the knowledge and acceptability of cervical cancer screening among Female Part- Time Students in University of Benin. It is envisaged that the findings from this study will be used by the health care team to increase strategies on increasing knowledge and awareness on cervical cancer screening to women. Findings will also be used in planning and designing training manuals and guidelines and formulating deliberate policies in training nurses, doctors and other health personnel involved in the fight against cervical cancer. It has also been found appropriate to carry out this study because the results will be used to influence women’s behavior and practice towards cervical cancer screening in a positive way. Furthermore, the study results will form a basis for further research on cervical cancer screening.Cervical Cancer Screening Among Female Part-Time Students Essay

RESEARCH QUESTIONS

1. What is the level of cervical cancer awareness among the respondents?

2. What is the level of acceptability of cervical cancer screening?

3. What are the barriers to cervical cancer screening?

HYPOTHESIS

There is no relationship between knowledge of cervical cancer and acceptability of cervical cancer screening.

LIMITATIONS OF THE STUDY

1. The study was conducted within a short period of time which made it impossible for the researcher to conduct the research on a bigger scale.

2. There was limited published literature on knowledge of cervical cancer and cervical cancer screening in Nigeria, as a result much of the literature review was from other countries.

SCOPE OF THE STUDY

Research setting is the physical location and conditions in which data collection takes place in the study, (Polit & Beck, 2008). The research setting can be seen as the physical, social, and cultural site in which the researcher conducts the study (Bhattacharya, 2008).The area of study is the University of Benin, Benin City, Edo state. University of Benin, Benin City, is geographically located at Ugbowo Community, in Ovia North East Local Government Area of Edo State. University of Benin is situated on 1,748 hectares of land along Benin – Lagos Highway. It shares a main boundary with University of Benin Teaching Hospital and Isiohor community. University was founded in the year 1970; her motto is “knowledge for service”. It is made up of 10 faculties namely; Agriculture Arts, Education, Engineering, Law, Life Science, Management Science, Pharmacy, Physical Science, Social science and School of Basic Sciences, College of Medicine and Dentistry.Cervical Cancer Screening Among Female Part-Time Students Essay

CONCEPTUAL DEFINITIONS OF TERMS

Cervical cancer: Cervical cancer is a cancer of the cervix or neck of the uterus (Altaian & Sarg, 2006).

Screening: Screening is a test used to try and detect a disease when there is little or no evidence that a person has a disease (Berkow & Beer, 2007).

Pap smear: Pap smear is the cytological gynecologic test that examines the structure, function, pathology and chemistry of the cell (Black & Hawks, 2005).

Knowledge: Information, understanding, or skill that you get from experience or education.

Awareness: the state of being aware of something (Merriam _ Webster Dictionary).

Acceptability: Acceptability is a state of welcoming something or acknowledging something (Geddes and Crosset, 2006).

OPERATIONAL DEFINITION TERMS

Knowledge: In this study knowledge means a woman who was able to define cervical cancer, state risk factors, signs and symptoms and mentioned services available for detection and prevention of cervical cancer.Cervical Cancer Screening Among Female Part-Time Students Essay

Acceptability: In this study acceptability means a woman who was able to acknowledge the importance of screening for cervical cancer, had the intensions of going for cervical cancer screening and had accessed the screening service.

Cervical cancer: In this study, cervical cancer means a growth or a sore on the cervix or uterus. Cervical Cancer Screening Among Female Part-Time Students Essay