Factors Associated with Late Diagnosis of Cervical Cancer in Nepal


Background: The majority of cervical cancers, the most prevalent cancer among Nepali women, are diagnosedin advanced stage leading to high mortality in Nepal. The present study explored factors associated with latediagnosis. Materials and
Methods: A cross-sectional study was carried out in two specialized cancer hospitalsof Nepal from August 12 to October 12, 2012. Randomly selected 110 cervical cancer patients were interviewedand their medical records were reviewed. Multivariate logistic regression analysis was performed to predictassociations.
Results: Mean age of patients was 52.7years (SD=10.6), 66% were illiterate and 77% were ruralinhabitants. Medical shops (33.6%) and private hospitals (31%) were major first contact points of patientswith health care providers (HCP). There was no cervical/per-speculum examination (78.2%) and symptomsmisinterpretation (90%) of patients occurred in initial consultation with HCP. Four in every five cases (80.9%)of cervical cancer had late diagnosis. Literate women (adjusted OR=0.121, CI: 0.030-0.482) and women havingabnormal vaginal bleeding as early symptom (adjusted OR=0.160, CI: 0.035-0.741) were less likely to suffer latediagnosis. Women who shared their symptoms late (adjusted OR=4.272, CI: 1.110-16.440) and did so with peopleother than their husband (adjusted OR=12.701, CI: 1.132-142.55) were more likely for late diagnosis.
Conclusions:High level of illiteracy among women and their problematic health seeking behavior for gynecological symptomsare responsible for late diagnosis of cervical cancer in Nepal. In the absence of a routine screening program,prevention interventions should be focused on raising awareness of gynecological symptoms and improvinghealth seeking behavior of women for such symptoms.