Screening for cervical cancer: an exploratory study of urban women in Tamil Nadu, India

Cervical cancer is the single most common cancer in India, affecting an estimated 134,420 women in 2008. With access to early detection and basic treatments, most cases of cervical cancer are preventable. Moreover, if treatment is administered during the earliest stages of cervical cancer, 5-year survival rates can be increased to higher than 90 percent. Unfortunately, despite the availability of methods for prevention, more than 95 percent of women in India have never been screened for cervical cancer. Consequently, women in India are most often diagnosed during later stages of cervical cancer, significantly reducing survival prognosis. The objective of this study was to explore the role of awareness and knowledge of cervical cancer as a barrier to screening participation among urban women in Tamil Nadu; and further to identify the potential impact of increased cervical cancer awareness and knowledge on screening attitude. Quantitative and qualitative methods were used to characterize existing levels of awareness and knowledge of cervical cancer and screening among 207 women from the metropolitan area of Chennai. The results suggest that the majority of women (69.6%) were not aware of cervical cancer and very few (16.4%) were aware of screening. Demographically, women with secondary levels of education or higher were significantly more likely to have heard of cervical cancer and screening. Of the women that were aware of cervical cancer screening, most reported receiving information through television (33%) or a healthcare provider (28.6%).

To describe the potential benefit of providing women with basic information about the secondary prevention of cervical cancer, levels of knowledge, measured before and after an educational session, were compared. This study further explored changes in associations between awareness, knowledge, perceived susceptibility, and screening attitude. It was observed that an overwhelming majority of women were receptive to participating in free cervical cancer screening, independent of previous knowledge of cervical cancer. Results also suggest that although lack of awareness appears to be a major barrier to participation in cervical cancer screening, providing women with information about cervical cancer has the potential to change the attitude of a significant proportion (58.3%) of women who were previously unreceptive to screening. Further, perceived susceptibility to cervical cancer appeared to be strongly associated with a positive screening attitude before and after receiving information. Finally, we examined and compared the socio-demographic characteristics of three subgroups of women: those who were receptive to screening without information, those who were receptive to screening after receiving information, and those who were not receptive to screening at either point. We found that younger, more educated women were receptive to screening without information. In addition, previously unscreened women who were less educated and illiterate in Tamil were most likely to acquire a positive attitude toward screening after receiving information. It also appeared that women who were most likely to be unreceptive to cost-free cervical cancer screening were more likely to be older and previously screened. These findings from our exploratory research with insights from additional comments made by several participants who were unreceptive to cost-free screening suggest that perceptions of free versus private healthcare may have influenced responses in this study.