Implementing a Cervical Cancer Awareness Program in Low-income Settings in Western China: a Community-based Locally Affordable Intervention for Risk Reduction

Background: Some 60 years after introduction of the Papanicolaou smear worldwide, cervical cancerremains a burden in developing countries where >85% of world new cases and deaths occur, suggesting a failureto establish comprehensive cervical-cancer control programs. Effective interventions are available to controlcervical cancer but are not all affordable in low-income settings. Disease awareness saves lives by risk-reductionas witnessed in reducing mortality of HIV/AIDS and smoking-related cancers. Subjects and
Methods: We initiateda community-based awareness program on cervical cancer in two low-income Muslim Uyghur townships inKashi (Kashgar) Prefecture, Xinjiang, China in 2008. The education involved more than 5,000 women fromtwo rural townships and awareness was then evaluated in 2010 and 2011, respectively, using a questionnairewith 10 basic knowledge questions on cervical cancer. Demographic information was also collected and includedin an EpiData database. A 10-point scoring system was used to score the awareness.
Results: The effectivenessand feasibility of the program were evaluated among 4,475 women aged 19-70 years, of whom >92% lived on/below US$1.00/day. Women without prior education showed a poor average awareness rate of 6.4% (164/2,559).A onetime education intervention, however, sharply raised the awareness rate by 4-fold to 25.5% (493/1,916).Importantly, low income and illiteracy were two reliable factors affecting awareness before or after educationintervention.
Conclusions: Education intervention can significantly raise the awareness of cervical cancer inlow-income women. Economic development and compulsory education are two important solutions in raisinggeneral disease awareness. We propose that implementing community-based awareness programs against cervicalcancer is realistic, locally affordable and sustainable in low-income countries, which may save many lives overtime and, importantly, will facilitate the integration of comprehensive programs when feasible. In this context,adopting this strategy may provide one good example of how to achieve “good health at low cost”.