RESUMEN
Purpose Cervical cancer is an important cause of mortality in low- and middle-income countries. Although screening technologies continue to improve, systems of care remain fragmented. It is important to better understand factors that affect use of screening services and loss to follow-up along the care continuum. Methods We conducted a mixed-methods study of a cytology-based screening program in rural Guatemala. A retrospective electronic chart review was performed on data from all patients from 2013 to 2014. We analyzed progression through care and calculated loss-to-follow-up rates. We also analyzed the prior experiences of patients with cervical cancer screening on the basis of self-reported historical data available in the chart review. Structured interviews with a subset of individuals to explore social supports and barriers to screening and engagement in care were conducted at the time of screening. Results The analysis included 515 women (median age, 36 years). Cytologic screening showed concern for neoplastic changes in 0.83%; half resulted in biopsy-proven cervical intraepithelial neoplasia. An additional 9.9% showed severe inflammation. The rate of loss to follow-up was 11.3%. All losses to follow-up occurred for severe inflammation, not for cervical intraepithelial neoplasia. Historical data showed that 73% of the cohort had previously been screened and had high levels of loss to follow-up (57.4%). Qualitative interviews revealed factors that promoted loss to follow-up; these included cost, lack of social supports, transportation, distrust in public facilities, long turn-around times, and failure to return test results or offer follow-up treatments. Conclusions Taken together, these quantitative and qualitative results highlight the need for cervical cancer screening programs in Guatemala to improve uptake of screening services by eligible women and to improve follow-up after a first abnormal screen.
Asunto(s)
Neoplasias del Cuello Uterino/diagnóstico , Adulto , Detección Precoz del Cáncer , Femenino , Guatemala , Humanos , Estudios RetrospectivosRESUMEN
In Costa Rica, cervical cancer is the second most common female cancer, despite accessibility of screening through the universal health care system. There is little understanding of knowledge levels of the adolescent population on cervical cancer, although this population is the most exposed to risk factors. This study sought to learn about male and female adolescent knowledge of preventative methods, infection acquisition, clinical manifestations and medical services. A total of 533 students from grades 7-12 from five public high schools in the rural San Carlos region participated in the study from March through April 2012. Students were found to lack knowledge, as only 30.8% of students stated that they knew what cervical cancer is. Additionally, a connection was lacking between cervical cancer concepts, as for example 75.2% of students had heard of Human Papiloma Virus, but only 33.9% of those students knew that HPV is related to cervical cancer. Age had a positive relationship with knowledge of main concepts (p < 0.001). More women than men had heard of cervical cancer and the Papanicolaou (p = 0.025, p < 0.0001), but otherwise no significant difference in mean response between genders was found. Students were found to have a limited awareness of the educational cervical cancer campaign (7.7% of the student population) and the ability to go alone to the doctor to receive medical attention (30.6% of students). Additionally, the public education system does not require cervical cancer to be included in the present curriculum. Hence, as students lack education on prevention and risk factors, the majority of prevention responsibility falls only on the universal health care system to regularly perform Papanicolaou exams to detect pre-cancerous or cancerous changes. The findings indicated the importance of including cervical cancer in the sexual education curriculum of the public education system in Costa Rica to educate the at-risk population of preventative methods, infection development, clinical manifestations and medical services in order to lower the presence of cervical cancer.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Vacunas contra Papillomavirus , Conducta Sexual , Estudiantes , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Adulto , Niño , Costa Rica , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Neoplasias del Cuello Uterino/virología , Adulto JovenRESUMEN
In Costa Rica, cervical cancer is the second most common female cancer, despite accessibility of screening through the universal health care system. There is little understanding of knowledge levels of the adolescent population on cervical cancer, although this population is the most exposed to risk factors. This study sought to learn about male and female adolescent knowledge of preventative methods, infection acquisition, clinical manifestations and medical services. A total of 533 students from grades 7-12 from five public high schools in the rural San Carlos region participated in the study from March through April 2012. Students were found to lack knowledge, as only 30.8% of students stated that they knew what cervical cancer is. Additionally, a connection was lacking between cervical cancer concepts, as for example 75.2% of students had heard of Human Papiloma Virus, but only 33.9% of those students knew that HPV is related to cervical cancer. Age had a positive relationship with knowledge of main concepts (p≤0.001). More women than men had heard of cervical cancer and the Papanicolaou (p=0.025, p≤0.0001), but otherwise no significant difference in mean response between genders was found. Students were found to have a limited awareness of the educational cervical cancer campaign (7.7% of the student population) and the ability to go alone to the doctor to receive medical attention (30.6% of students). Additionally, the public education system does not require cervical cancer to be included in the present curriculum. Hence, as students lack education on prevention and risk factors, the majority of prevention responsibility falls only on the universal health care system to regularly perform Papanicolaou exams to detect pre-cancerous or cancerous changes. The findings indicated the importance of including cervical cancer in the sexual education curriculum of the public education system in Costa Rica to educate the at-risk population of preventative methods, infection development, clinical manifestations and medical services in order to lower the presence of cervical cancer. Rev. Biol. Trop. 62 (3): 877-886. Epub 2014 September 01.
En Costa Rica, el cáncer de cérvix es el segundo tipo de cáncer femenino más común, a pesar de la accesibilidad del Papanicolaou gracias al sistema de salud universal. No se ha evaluado el nivel de conocimiento de la población adolescente sobre el cáncer de cérvix, aunque este grupo es el más expuesto a los factores de riesgo. Este estudio investigó cuánto sabe el adolescente sobre métodos de prevención, riesgo de infección, manifestaciones clínicas y servicios médicos. En total, 533 estudiantes de séptimo a doceavo año de cinco colegios públicos de la zona rural de San Carlos participaron en esta investigación durante marzo y abril 2012. Se observó que los estudiantes carecen de información, ya que solamente el 30.8% sabían qué es el cáncer de cérvix. Nuestros resultados indican que es importante incluir el cáncer de cérvix en los programas de educación sexual del sistema de educación pública de Costa Rica, para educar a la población en riesgo acerca de los métodos de prevención, desarrollo de la infección y servicios médicos.