PREVALENCE, ASSOCIATED RISK FACTORS AND METHODS OF DIAGNOSING CERVICAL CANCER IN TWO HOSPITALS IN YAOUNDE, CAMEROON

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1 Available online on Research Article Received on 15/12/2012; Revised on 21/12/2012; Accepted on 23/12/2012 PREVALENCE, ASSOCIATED RISK FACTORS AND METHODS OF DIAGNOSING CERVICAL CANCER IN TWO HOSPITALS IN YAOUNDE, CAMEROON Emmanuel N Tufon., Yuwun Novert, B., Egba, Simeone, I and Ndohnui, N. Noel Department of Medical Biochemistry St. Louis University Institute of Health and Biomedical Sciences Mile 3 Nkwen, Bamenda Department of Medical Biochemistry, University of Nigeria, Nsukka Nigeria Department of Medical Diagnostic Imaging and Radiation Therapy St. Louis University Institute of Health and Biomedical Sciences Mile 3 Nkwen, Bamenda ABSTRACT Cancer of the cervix is the leading cause of mortality in women in developing countries. This study was therefore aimed at evaluating the prevalence, associated risk factors and methods of diagnosing cervical cancer in two hospitals in Yaounde, Cameroon. A cross sectional hospital based descriptive design was used in which 244 women who came for cancer screening were randomly selected to take part. Data was collected through the use of a questionnaire survey. From the results obtained, the prevalence of cervical cancer was shown to be 29.1% and the most prevalent risk factors were poor level of awareness of the disease prevention (94.68%), the presence of STIs (74.19%), prolonged use of pills (58.20%) and multiple sexual partners (54.51%). Cytology, biopsy and histology (47.22%) were the most commonly used methods of diagnosing cervical cancer in the study area. In conclusion, the prevalence of cervical cancer was high with the most prevalent risk factor being poor level of awareness of the disease prevention. KEYWORDS: cervical cancer, prevalence, risk factors, diagnosis, Yaounde, Cameroon INTRODUCTION Cervical cancer continues to be a significant health threat to women. Worldwide, cervical cancer is currently the fifth most deadly cancer in women (WHO, 2009). It is estimated that 200,000 to 300,000 women die from cervical cancer every year, mostly in poorer countries (Parkin et al, 1993; Franco and Monsonego, 1997). In terms of the causes of cervical cancer, it is now established that human papilomavirus (HPV) is the central etiological factor of cervical neoplasia. Studies using advanced polymerase chain reaction (PCR) technology have reported that over 95% of invasive cervical cancer cases worldwide have HPV markers (Sankaranarayanan and Pisani, 1997). Cofactors such as parity, use of oral contraceptives, tobacco smoking, immunosuppression particularly related to human immunodeficiency virus (HIV) infection with other sexually 2011, IJARPB. All Rights Reserved 55

2 transmitted diseases and poor nutrition have all been associated to various extent with the development of invasive cervical cancer (kols and Sherris, 2000). One of the most important reasons for the incidence of cervical cancer in developing countries is the lack of early detection of pre cancerous lesions and treatment of the lesions before they progress. In most countries, papanicolaou (Pap) smear (cervical cytology test) is the standard screening method. Unfortunately, pap screening is practically non existent in most countries in low resource settings and even when performed, it is expensive for an ordinary woman. Although cervical cancer is preventable and curable if detected early, its morbidity and mortality continue to be on the increase in developing countries. This study therefore focuses on the prevalence, associated risk factors and methods of diagnosing cervical cancer in two hospitals in Yaounde, Cameroon. MATERIALS AND METHOD Study Area This cross sectional hospital based descriptive study was conducted at the Yaounde General hospital and the Yaounde Gyneco Obstetric and Pediatric hospital all located in Ngosso in the central region of Cameroon. These hospitals were purposively selected because of the existence of a screening program there. Study Population: A total number of 244 women and 36 health personnels were randomly selected to take part in the study using a simple random sampling technique. Data collection: Pre tested standard questionnaires were administered to selected participants to collect data on the risk factors. Data on the methods of diagnosis was obtained using a semi structured pre tested questionnaire issued to health personnels working in the cancer diagnostic unit. Data Analysis: The responses given by the participants were coded before data entry and analyzed using SPSS version The results obtained are presented in the form of percentages. Ethical Consideration: Data was obtained only after the participants had signed an informed consent form. Full confidentiality and individuals rights were maintained. Authorization was sought from the directors of the above mentioned hospitals. RESULTS Prevalence of cervical cancer: Out of the 244 women selected, 71 were screened positive giving a prevalence of 29.1%. Distribution of risk factors of cervical cancer: From the table below, the most prevalent risk factors were poor level of awareness of the disease prevention (94068%), the presence of STIs (74.18%), prolonged use of pills (58.20%) and multiple sexual partners (54.51%). 2011, IJARPB. All Rights Reserved 56

3 Table 1: Distribution of the study population according to risk factors of cervical cancer Factors Influencing Cervical Cancer Distribution Amongst the Study Population (%) (n = 244) STIs (181) Early Sexual Engagement Before 15 years (118) After 15 years (110) Could not remember 6.56 (16) Sexual Partners Multiple (133) Single (111) Prolonged Use of Pills ( 4 years) (142) Awareness of the Disease Prevention Can be prevented 5.32 (13) Cannot be prevented (82) (149) Don t know Smokers All women were non smokers Family History of Cervical Cancer (13) Had Family History of Cervical Cancer (157) No Family History of Cervical Cancer (40) Don t know METHODS OF DIAGNOSING CERVICAL CANCER: The results on the methods of diagnosing cervical cancer showed that majority of the health personnels (47.22%) used cytology, biopsy and histology. Table 2: Distribution of the methods of diagnosing cervical cancer based on the frequency of usage by health personnels Methods of Diagnosis Health Personnels (%) (n = 36) Cytology, Biopsy and Histology (17) Intravenous Urography and PCR 5.56 (2) Colposcopy and Endoscopy 8.33 (3) CT Scan, Echography and X - rays (14) DISCUSSION Cervical cancer is more prevalent in developing countries than developed ones and the mortality from cervical cancer in Africa is very high (Sankaranarayanan and Ferlay, 2006). The result on the prevalence of cervical cancer according o this study was high (29.1%) which is similar to the report of Chukunonga and Bassett in 1998 that the most common cancer found amongst Zimbabwean women was cervical cancer (28.3%). 2011, IJARPB. All Rights Reserved 57

4 Based on the risk factors, poor level of awareness of the disease prevention was the most prevalent (94.68%) which was not encouraging. This result is in line with the findings of Sreejata and Sukanta (2012) who reported in that 96.4% of the population were not aware of the causes of cervical cancer, 93.7% were not aware of the signs and symptoms and 96.4% of the prevention of cervical cancer. They also found a significant association between the level of education and awareness of the disease. The presence of STIs was also prevalent (74.18%) amongst the study population which is similar to the report of Kols and Sherris in 2000 that immunosuppression particularly to human papilomavirus (HPV) and human immunodeficiency virus (HIV) infections with other sexually transmitted diseases have been associated to various extents with the development of invasive cervical cancer. Studies by Parazzini et al, 1990 showed a relationship between the use of oral contraceptives and the incidence of cervical cancer particularly for long term users as was observed in this study (58.2%). According to Mitra in 2009, early sexual engagement eposes the young subjects to semen which is a potential carcinogen. This study considered early sexual engagement to be before 15 years of age which is slightly different from that of Munoz et al, 2002 and Merill et al, 2005 who considered sex less than 18 years of age as early sexual engagement. However, the importance of early coitus lies in the fact that intercourse introduces a carcinogenic agent to the cervical epithelium which is most susceptible during adolescence (Biswa et al, 1997). In connection, most of the participants had multiple sexual partners (54.21%) which has been shown in previous studies to increase the risk of cervical cancer. In the present study, the family history of cervical cancer of 47 respondents was positive (19.26%). Sreejata and Sukanta (2012) established an association between the area of residence and the presence of family history of cervical cancer. They reported that urban population showed a higher percentage than rural population. The present study was carried out in Yaounde which is an urban area; this may explain the reason for the 47 respondents found positive for family history of cervical cancer. One of the most important reasons for the high incidence of cervical cancer in developing countries is the lack of early detection of pre cancerous lesions and treatment of the lesions before they progress. In most countries, the papanicolaou (Pap) smear (cytology test) is the standard screening method. The result of this study showed that majority of the health personnels (47.22%) used cytology, biopsy and histology. Our findings show that the prevalence of cervical cancer was high (29.1%) with the major risk factor being poor level of awareness of the disease prevention (94.68%). Since the hospital studied used standard methods of screening for cervical cancer, the researchers therefore strongly recommend that educating the population will play an important role in generating awareness amongst the population at large. ACKNOWLEDGEMENT The authors would like to express their thanks and appreciation to the C.E.O of St Louis Group; Dr. Nick Ngwanyam and to all the authorities and staff of the Yaounde General hospital and the Yaounde Gyneco Obstetric and Pediatric hospital who co operated in conducting this research. 2011, IJARPB. All Rights Reserved 58

5 REFERENCES 1. Biswa, L.N., Manna, B., Maiti, P et al (1997). Sexual Risk Factors for Cervical Cancer amongst Rural Indian Women: A case control study. Int.J.Epidemiol 26: Chokunonga, E and Bassett, M.T (1998). Pattern of Cancer in Zimbabwe. Zimbabwe National Cancer Registry Annual Report 3. Franco, E and Monsonego, J (1997). New Developments in Cervical Cancer Screening and Prevention. Blackwell Science Ltd, Oxford, United kingdom 4. Kols, A and Sherris, J (2000). HPV vaccines: Promises and Challenges. Program for Appropriate Technology in Health (PATH) 5. Mitra, S (2009). Study of the Risk Factors for Cervical Cancer in a Speciality hospital in Kolkata. J. Com Med.5: Munoz, N., Franceschi, S., Boselti, C et al (2002). Role of Parity and Human Papilomavirus in Cervical Cancer. IARC multicentricase control study. Lancet 559: Parazzini, F., La Vecchia, C., Negri, E and Maggi, R (1990). Oral Contraceptive use and Invasive Cervical Cancer. Int. J. Epdemiol. 19: Parkin, D.M., Pisani, P and Ferlay, J (1993). Estimates of the Worldwide Incidence of Eighteen Major Cancers in International Journal of Cancer 54: Sankaranarayanan, R and Ferlay, J (2006). Worldwide Burden of Gynaecological Cancer: The Size of the Problem, Best Practices and Research Clinical Obstetrics and Gynaecology. 20 (2): Sankaranarayanan, R and Pisani, P (1997). Prevention Measures in the Third World: Are they Practical? In Franco E, Monsonego J (eds), New Development in Cervical Cancer Screening and Prevention, Oxford, Blackwell Science: Sreejata, R and Sukunta, M (2012). Socio Demographic and Behavioral Risk Factors for Cervical Cancer and Knowledge, Attitude and Practice in Rural and Urban Areas of North Senegal, India Asian pacific Journal of Cancer Prevention 13 (4): World Health Organization (2009). Cancer. available at s/fs297/en/index.html.accessed January 18, , IJARPB. All Rights Reserved 59

STUDY OF EARLY DETECTION OF CERVICAL CANCER BY PAP S SMEAR IN SELECTED SETTING OF PUDUCHERRY

STUDY OF EARLY DETECTION OF CERVICAL CANCER BY PAP S SMEAR IN SELECTED SETTING OF PUDUCHERRY *Thirumurugan. P, **Premila. E, ***Suresh Kanna. K *Associate Professor, Mother Theresa Post Graduate and Research