Journal of Clinical Trials and Regulatory Affairs

Assessment of Sociodemographic Profile, Risk and Delay Factors of Cancer Cervix in Bangladesh

Author(s): Mazumder U, Rouf S, Sarkar S

Background: Cervical cancer is one of the most significant causes of morbidity and mortality among females worldwide. It is the third most cancer worldwide, and 80% of cases occur in the developing countries. It is the leading cause of death from cancer among women where it causes 190,000 deaths each year. Also, the cervical cancer prevalence in Bangladesh is quite high. Every year approximately 11956 women are diagnosed cervical cancer in Bangladesh. Every day 18 women die due to cervical cancer. Every year approximately 6582 women die due to cervical cancer in Bangladesh. The risk factors of the cervical cancer are early age of marriage, early sexual exposure, repeated child birth, multiparity, promiscuity, poor hygiene, poor nutrition, oral contraceptive pill, smoking, family history of cervical cancer etc. 
Objective: The objectives of the study are to assess the socio-demographic profile and to identify the risk factors and the factors causing the delay in management of cervical cancer. 
Methodology: This cross sectional study was conducted from July 2013 to June 2015 in Obstetrics and Gynaecology department, Dhaka Medical College hospital, Dhaka, Bangladesh. 200 patients of biopsy proved cancer cervix were included in this study. Non-probability purposive sampling method was used for selection of patients. 
Results: In this study, Socio-demographic profiles, Identification of risk factors, and the factors causing the delay in management of cervical cancer were assessed. Among new patients seeking treatment from the department, 200 new cases of carcinoma of uterine cervix were considered for the study. Mean age of patients with carcinoma cervix in our study was 47.9 ± 8.89 years. 41% belonged to the age group of 41 to 50 years and 27.5% were of the age group 51 to 60 years. In this study, 44% belonged to BPL (below poverty line) category. Majority (56.5%) of the patients was illiterate and multiparous (96%). 130 patients (65%) got married between the age ranges of 10-15 years and had first coitus before age of sixteen. Most counted age range of first child birth was 16-20 years (57.5%). Most common presentation was with foul smelling/ blood stained P/V discharge (78.5%; 157 out of 200 cases). Only 27 cases (13.5%) had done cervical screening at least once previously. The rest 173 cases (86.5%) did not know about any kind of cervical screening method. For quantitative comparison of the delays in between different levels of health providing sector here in Bangladesh, we categorized the intervals and patterns of referrals. In most cases (89.5%), the 1st reporting health care provider was a doctor. Majority of the cases were referred from private clinics (44%) and other medical colleges or tertiary level hospitals (35%). Interval between appearance of symptoms and first reporting to health care provider was more than 1 year in 30% cases whether between first reporting and clinical diagnosis it was found to be more than 6 months in 28% cases. The interval between clinical and histological diagnosis was more than 1 month in 32% cases and that between histological diagnosis and getting appropriate treatment was more than 1 month in 33.5% cases. With a view to searching for the delay in diagnosis in 56 out of 200, negligence of the patients and her relatives toward the symptoms was found to be the most important cause (12.5%) for the delay of diagnosis. The other prevalent causes were financial crisis (9%) and taking homeopathic and unscientific treatments (9%). False negativity of the screening test was responsible in 6 of the cases. In some cases (7 cases) doctors were responsible too, by failure to diagnosis and even malpraxis. In searching for the delay in treatment of cancer cervix in 67 out of 200, 16.5% of those cases were cause of the delay in hospital due to long queue of operations (3%) or radiotherapy (13.5%). Financial crisis was also responsible for delay in treatment for 28 cases. Others were not fit for the operation. 
Conclusions: A large number of risk and delay factors in the management of cancer cervix were identified in this study. So, regular cervical screenings are necessary to reduce the incidence and mortality from cervical cancer. Failure of proper and timely referral is one of the important causes of delay in diagnosis and treatment.

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