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Shakuntala Chhabra*, and Mandar Karambelkar
Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
Corresponding author : S. Chhabra
Director Professor, Obstetrics & Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
Tel: +91-7152-284342 to 55; Ext: (O): 321, 307, (R): 221; Fax: +91-7152-284286; E-mail: [email protected]
Received: March 10, 2014 Accepted: May 23, 2014 Published: May 27, 2014
Citation: Chhabra S, Karambelkar M (2014) Original Research Article Cervical Cancer, Pre-cancer Knowledge, Attitude and Practices. Androl Gynecol: Curr Res 2:4. doi: 10.4172/2327-4360.1000127



Cervical Cancer; Knowledge; Attitude; Practices; Rural; Urban screening


Cervical cancer, is a leading cause of cancer mortality, [1] with 500,000 estimated cases and 280,000 estimated deaths reported annually, almost 80% are from low-resource countries. By diagnosis of cervical precancer disease, cancer can be prevented and if cancer is diagnosed early, death can be prevented. With a multitude of known risk factors it accounts for 15% of female cancers, with a cumulative risk of 1.5% in developing countries, and 0.8%, in developed countries before age 65 years [2]. It is a leading cancer among Indian women; with about 20% of all the cancer related deaths in women, it is number one cause of death in middle aged Indian women [3]. It is essential to try prevention for which knowledge of the disorder, positive attitude towards prevention, screening and therapy are all essential. Cervical precancer, early stage cancer can be detected even with visual inspection and Papanicolaou (PAP) test. Lowy report that down-staging programs for diagnosis at early stage and prevention of cervical cancer, (visual inspection and PAPs test), have reduced the incidence, still it remains the second most common cause of cancer deaths in women worldwide [4]. Success of the screening programs, (screening uptake or high level of screening attendance) primarily depend on, knowledge and attitude. Sometimes cervical cancer may be slow growing. Women have only vaginal discharge for a long time until the late stages when chances of survival become low, however aggressive fast growing disease is also known [5,6]. Objective of the study was to find out the level of Knowledge, Attitude & Practices for prevention of precancer, cervical cancer amongst women (rural & urban) so as to plan measures for preventing cancer and its mortality.

Materials and Methods

This cross sectional study was done in 1000 women, (658 urban 342 rural) of 30-60 years age included randomly out of the women who visited Obstetrics & Gynaecology outpatient of the rural referral institute (one) over 12 months. Randomly women who visited gynaecology outpatient for any illness but were not really sick and were willing to be part of study were interviewed between mid 2012 to mid 2013. Everyday 30 to 60 gynaecological patients report, 5 women willing to be part of study were randomly included. After having finished one interview through a predesigned questionnaire the social worker assigned the job, took another case. Confidentiality was assured and ensured. No one was given questionnaire, answers given were written on the questionnaire. Necessary permission from the ethics committee was taken and also informed consent of the women was taken. Information was collected by asking questions in local language using predesigned questionnaire. Statistical analysis was carried out using EPI - INFO software version 6.0.


Of the 1000 women 38.5% (385), knew something about cervical cancer, precancer like they knew, there is some such cancer, 61.5% (615), had not even heard about the disorder. Of the 385 women who knew about cervical cancer also, 190 had only heard about the condition, 104 were aware about some causes of the disorder, 5.7% (57) were aware about prevention. Only 3.4% (34) women could tell some symptoms of the cervical precancer, cancer (Figure 1). Of the 38.5% (385) women with knowledge, more out of rural, 40.64% (139 of 342) than urban 37.39% (246 of 658) (P-Value: 0.315) (Figure 2). Source of knowledge of urban women was mainly television and radio. Though some rural women also said that their source was television, many rural women said that most of whatever they knew was from social workers, nurse midwives during service camps in their villages. Of 385 women who had little knowledge, 80.25% (309) had positive attitude towards screening, (overall 30.9% of 1000 women) (Figure 3). With increasing education more women had positive attitude. Only 12.35% (31 of 251) among illiterate had positive attitude, which peaked at 81.25% (13 of 16) in those with post graduate degree (P Value: <0.001), however many women (26.1% (261 of 1000) had only primary education (Class I to V) with positive attitude for screening only in 18.39% (64 of 261) (Figure 4). Similarly increasing trend in positive attitude was observed in women with better socioeconomic status, least, 8.70% (20 of 230) in the below poverty line, 45% (9 of 20) in upper class. From upper middle class there was highest percentage of positive attitude 60.71% (34 of 56) (Figure 5). Over all 259 of 1000 (25.90%) women, 83.81% of the 309 women with positive attitude and 67.27% of 385 women with little knowledge had undergone screening for cervical cancer, precancer prior to the study. Similar to the positive attitude, there was progressive improvement in screening practices with education, over all 5.18% (13 of 251 amongst illiterate) and 81.25% (13 of 16) of postgraduates (P-Value: <0.0001) had undergone screening, similarly 7.38% of below poverty line (18 of 230) and 45% (9 of 20) upper class had undergone screening prior the study.
Figure 1: Details of Knowledge.
Figure 2: Knowledge Attitude & Practices – Rural & Urban.
Figure 3: Knowledge Attitude & Practices – Age wise.
Figure 4: Knowledge, Attitude & Practices according to Education.
Figure 5: Knowledge, Attitude & Practices according to Socio-economic status.


Cervical cancer is the single largest killer of middle aged women in India [7]. India bears one fifth of the world’s burden of cervical cancer [8]. As per National Cancer Registry, crude incidence and mortality rate due to cervical cancer in India is 134 per 1000 and 74 per 1000 women respectively [9]. Also, it has been reported that 50% of women diagnosed with cervical cancer had never undergone a Pap test [10]. They seek care in advanced stage of cervical cancer in India [11,12]. The reasons may be lack of access to screening / therapy [13]. Also screening is less likely if there is lack of understanding of the importance of prevention [14], lack of awareness of the benefits of the screening, considering oneself not at risk, fear of getting diagnosed as cancer and embarrassment [11,13]. In the present study also; there was overall lack of awareness about cervical cancer, precancer amongst many rural 59.36% (203 of 342) as well as urban 62.61% (412 of 658) women. Of the illiterate less had knowledge and more of those with post graduate degree (be it rural or urban) had knowledge of cervical cancer, precancer Also more of rural women had knowledge than urban because of the practice of mass screening in rural community based screening programs. Such camps are usually not held in urban areas in this part as it is believed that urban women can seek services on their own. Asthana and Labani (2013) have reported that 72% women were aware of the cervical cancer and had knowledge of treatment possibility. A study conducted among 10036 Turkey women to identify knowledge about cervical cancer & Pap test and barriers of participation in screening revealed 64.4% women having heard about cervical cancer, 43.1% had heard about Pap test and only 24.7% had a pap test once. They found lack of awareness, feeling uncomfortable with the procedure and not knowing where to go for Pap test were the common barriers to undergo screening [15]. In the present study also very few were aware and those who were aware also had not undergone screening. Overall number of women with knowledge, right attitude & action for practices about cervical cancer, precancer improved steadily with increasing education. Positive attitude for screening was in much less number of illiterate and more of postgraduate studied women and more had undergone screening, prior to study, revealing the need for creating awareness. The opportunistic screening is done at many places, with or without knowledge of the women, even at the place of study. At many places PAPs smear is collected as and when possible, the slide is studied and report provided if it is free. But if the woman has to pay, sometimes the collected slide is not sent for processing or is sent for processing but report is not provided and even women do not ask for the report. The knowledge, attitude & practices (KAP) peaked in women with post graduate education. KAP was best in women from upper middle class and not in upper class. Of the 230 women from below poverty line only 13.48% (31) had some knowledge, 8.70% (20) had right attitude & 7.83% (18) had undergone screening, the trend peaked in upper middle class (56 women) 73.21% (41) had some knowledge, 60.71% (34) had right attitude& 44.64% (25) had practiced prevention. The trend declined marginally in upper class, of total 20 women, 60% (12) had heard about it, 45% (9) had right attitude & had actually undergone screening. More worrisome was the fact that 19.75% of women with knowledge had negative attitude towards screening.


Overall there is lack of awareness about cervical precancer, cancer in women, with a significant association with education. More of those who had higher education had knowledge of the disease.
Also more women with better socioeconomic status had knowledge, right attitude & practiced screening but education played major role, While necessary steps need to be taken to improve awareness with focus on resource limited socio-economic groups, every woman needs to be aware of the disorder & need to practice screening for prevention and early diagnosis.


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