Abstract:

Cervical cancer is one of the most common cancers that affect women worldwide. In developing countries, cancers are detected late due to limited access to preventative measures and late treatment options leading to higher death rates in these countries. The study was undertaken to determine the cervical cancer prevalence to aid in planning grass root level programs to reduce the morbidity and mortality from the disease. This study is a hospital-based retrospective design that reviewed reported screening test results of CCa cases in five screening centres identified in Enugu state. Reported data sets were analysed and one-sample t-test analysis of statistical significance was determined. A pooled total of 27 333 patients were screened using pap smear and 3528 tested positive for cervical cancer was reported over the five years period giving a prevalence rate of 13%. The mean age of the positive cases was 38.82 ± 8.15 years. The majority of the cases (62%) were recorded among the age group 30 – 39 years. The yearly rates included 14% prior to 2016, 12%, 9%, 20%, 13% and 10% for 2016, 2017, 2018, 2019 and 2020 respectively. T-test analysis showed a significant difference in testing rate when compared to previous study t = 5.7, p = .002. The prevalence of this study is high when as reported in previous studies. Therefore, a targeted awareness and enlightenment of the public on cervical cancer screening is highly recommended to ensure early detection which guarantees good treatment outcomes.

References:

[1] Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today.

[2] Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, Accessed [11 May 2022].

[3] Frazer, H. (2006) “Human papillomavirus vaccine,” International Journal of Gynecology & Obstetrics, vol. 94, pp. 381–388, 2006.

[4] Ugwu, E. O., Obi, S. N., Ezechukwu, P. C., Okafor, I. I., & Ugwu, A. O. (2013). Acceptability of human papillomavirus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria. Nigerian Journal of clinical practice, 16(2), 249-252.

[5] Akanbi, O. A., Iyanda, A., Osundare, F., & Opaleye, O. O. (2015). Perceptions of nigerian women about human papilloma virus, cervical cancer, and HPV Vaccine. Scientifica, 2015.

[6] World Health Organization. Human papillomavirus (HPV) and cervical cancer. https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(HPV)-and-cervical-cancer (Accessed 19^th May 2022).

[7] Devarapalli, P., Labani, S., Nagarjuna, N., Panchal, P., & Asthana, S. (2018). Barriers affecting uptake of cervical cancer screening in low- and middle-income countries: A systematic review. Indian Journal of Cancer, 55(4), 318.

[8] Escoffery, C., Rodgers, K.C., Kegler, M.C., Haardörfer, R., Howard, D.H., Liang, S., Pinsker, E., Roland, K.B., Allen, J.D., Ory, M.G. and Bastani, R., 2014. A systematic review of special events to promote breast, cervical, and colorectal cancer screening in the United States. BMC public health, 14(1), pp.1-13.

[9] Racey CS, Withrow DR, Gesink D (2013). Self-collected HPV testing improves participation in cervical cancer screening: A systematic review and meta-analysis. Can J Public Health 2013; 104:159-66. 15.

[10] Madzima TR, Vahabi M, Lofters A (2017). Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review. Can Fam Physician 2017; 63:597-601.

[11] Albrow R, Blomberg K, Kitchener H, Brabin L, Patnick J, Tishelman C, et al. Interventions to improve cervical cancer screening uptake amongst young women: A systematic review. Acta Oncol 2014; 53:445-51.

[12] Sabatino, S.A., Lawrence, B., Elder, R., Mercer, S.L., Wilson, K.M., DeVinney, B., Melillo, S., Carvalho, M., Taplin, S., Bastani, R. and Rimer, B.K., 2012. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. American Journal of Preventive Medicine, 43(1), pp.97-118.

[13] Crawford J, Ahmad F, Beaton D, Bierman AS. Cancer screening behaviors among South Asian immigrants in the UK, US, and Canada: A scoping study. Health Soc Care Community 2016; 24:123-53.

[14] McFarland DM, Gueldner SM, Mogobe KD (2016). Integrated review of barriers to cervical cancer screening in Sub-Saharan Africa. Journal of Nursing Scholarship, 48(5), 490-498.

[15] Lim JN, Ojo AA (2017). Barriers to utilization of cervical cancer screening in Sub Sahara Africa: A systematic review. Eur J Cancer Care (Engl) 2017;26. doi: 10.1111/ecc. 12444.

[16] Lu M, Moritz S, Lorenzetti D, Sykes L, Straus S, Quan H (2012). A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women. BMC Public Health 2012; 12:413.

[17] World Health Organization Screening for Cervical Cancer https://www.who.int/activities/screening-for-cervical-cancer accessed 30/01/2021.

[18] Agorye Ingwu, J. (2016). Knowledge and Screening Practices of Cervical Cancer among Pregnant Women Attending Antenatal Clinic in Tertiary Hospitals in Enugu, South-Eastern Nigeria. Journal of Cancer and Tumor International, 4(2), 1-9. https://doi.org/10.9734/JCTI/2016/27118.

[19] Schnatz P. F., Markelova N. V., Holmes D., Mandavilli S. R., and O’Sullivan D. M. (2008), “The prevalence of cervical HPV and cytological abnormalities in association with reproductive factors of rural Nigerian women,” Journal of Women’s Health, vol. 17, no. 2, pp. 279–285, 2008.

[20] Jeong S, Saroha E, Knight J, Roofe M, Jolly PE 2011. Determinants of adequate follow-up of an abnormal Papanicolaou result among Jamaican women in Portland, Jamaica. Cancer Epidemiol 2011; 35:211-6. 11.

[21] Hoque M, Hoque E, Kader SB. (2018) Evaluation of cervical cancer screening program at a rural community of South Africa. East Afr J Public Health 2008; 5:111-6. 12. Human papillomavirus (HPV) and cervical cancer.

[22] Uzochukwu, B., Onwujekwe, O., Soludo, E., Nkoli, E., & Uguru, N. (2009). The District Health System in Enugu state, Nigeria: an analysis of policy development and implementation. Enugu, Nigeria: Consortium for Research on Equitable Health Systems.

[23] WHO (2022) Cancer. Available at: https://www.who.int/health-topics/cancer#tab=tab_1 (Accessed 13th May 2022).

[24] Oketch SY, Kwena Z, Choi Y, Adewumi K, Moghadassi M, Bukusi EA, Huchko MJ. 2019. Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study. BMC Womens Health. 2019 Jun 13;19(1):75. doi: 10.1186/s12905-019-0778-2. PMID: 31196175.

[25] Udigwe, G. O. (2006). Knowledge, attitude, and practice of cervical cancer screening (pap smear) among female nurses in Nnewi Southeastern Nigeria. Nigerian Journal of clinical practice, 9(1), 40-43.

[26] Joseph, A., Olisaemeka, E. P., Chukwudi, O. R., Igwe, N. M., Agwu, M. R., & Egbuji, C. C. (2015). Frequency and pattern of gynecological cancers in a federal teaching hospital, Abakaliki, Nigeria. Journal of Basic and Clinical Reproductive Sciences, 4(2), 54-57.

[27] Chukwuali, L. I., Onuigbo, W. I., & Mgbor, N. C. (2003). Cervical Cancer Screening in Enugu, Nigeria. Tropical Journal of Obstetrics and Gynaecology, 20(2), 109-112.

[28] Dim C. C., Ezegwui H. U., Ikeme A. C., Nwagha U. I. & Onyedum C. C. (2011) Prevalence of cervical squamous intraepithelial lesions among HIV-positive women in Enugu, South-eastern Nigeria, Journal of Obstetrics and Gynaecology, 31:8, 759-762, DOI: 10.3109/01443615.2011.598967

[29] Daniel, G. O., Musa, J., Akindigh, T. M., Shinku, F., Shuaibu, S. I., Kwaghe, B., ... & Sagay, A. (2020). Prevalence and predictors of precancerous cervical lesions among HIV‐positive women in Jos, north‐central Nigeria. International Journal of Gynecology & Obstetrics, 151(2), 253-259.

[30] Ukah, C. O., & Nwofor, A. M. (2017). Cancer incidence in south-east Nigeria: a report from Nnewi cancer registry. Orient Journal of Medicine, 29(1-2), 48-55.

[31] Ajah, L. O., Ezeonu, P. O., Ozonu, N. C., Iyoke, C. A., Nkwo, P. O., & Ajah, M. I. (2015). A five-year review of cervical cytology in Abakaliki, Nigeria. Am J Cancer Prev, 3(2), 23-6.

[32] Ekwedigwe, K.C., Ezeonu, P.O., Edegbe, F., Esike, C., Agbata, A.T., Ukaegbe, C.I., Anozie, O.B., Asiegbu, O.G. and Isikhuemen, M., 2018. Prevalence and Pattern of Abnormal Pap Smear among Pregnant Women Attending Antenatal Clinic in a Missionary Hospital in Abakaliki, Southeast Nigeria. Open Journal of Obstetrics and Gynecology, 8(8), pp.728-740.

[33] Kani, Y. A., Muhammad, Y., Binji, A., Iliya, S., Adejumo, R., & Kamilu, I. M. (2020). Prevalence of cervical cancer-A 6-year Retrospective Study in Jigawa State, Nigeria. World Journal of Biology Pharmacy and Health Sciences, 4(1), 008-013.

[34] Gage, J. C., Ajenifuja, K. O., Wentzensen, N. A., Adepiti, A. C., Eklund, C., Reilly, M., ... & Schiffman, M. (2012). The age‐specific prevalence of human papillomavirus and risk of cytologic abnormalities in rural Nigeria: Implications for screen‐and‐treat strategies. International Journal of cancer, 130(9), 2111-2117.

[35] Nejo, Y. T., Olaleye, D. O., & Odaibo, G. N. (2018). Prevalence and risk factors for genital human papillomavirus infections among women in Southwest Nigeria. Archives of Basic and Applied Medicine, 6(1), 105.

[36] Kachalla, N. A., Isa, H., Bashir, M., & Yunana, S. Prevalence of Human Papilloma Virus among women of childbearing Age in Yola Adamawa State, Nigeria. UJMR, Volume 6 Number 2, December 2021, pp 24 – 29.

[37] Ezechi, O.C., Ostergren, P.O., Nwaokorie, F.O. et al. The burden, distribution, and risk factors for cervical oncogenic human papillomavirus infection in HIV-positive Nigerian women. Virol J 11, 5 (2014). https://doi.org/10.1186/1743-422X-11-5.

[38] Akarolo-Anthony, S.N., Al-Mujtaba, M., Famooto, A.O. et al. HIV associated high-risk HPV infection among Nigerian women. BMC Infect Dis 13, 521 (2013).

[39] Okolo, C., Franceschi, S., Adewole, I., Thomas, J.O., Follen, M., Snijders, P.J., Meijer, C.J. and Clifford, G.M., 2010. Human papillomavirus infection in women with and without cervical cancer in Ibadan, Nigeria. Infectious agents and cancer, 5(1), pp.1-4.

[40] Adegbesan Omilabu, M., Okunade, K., & Omilabu, S. (2014). Oncogenic human papillomavirus infection among women attending the cytology clinic of a tertiary hospital in Lagos, South-West Nigeria. Int J Res Med Sci, 2(2), 625.

[41] Mohammed, M. M. (2015). Prevalence of Cervical Human Papillomavirus Infection Among Women Presenting or Cervical Cancer Screening in Gombe North-Eastern Nigeria. Faculty of Pathology.

[42] Auwal, I. K., Aminu, M., Atanda, A. T., Tukur, J., & Sarkinfada, F. (2013). Prevalence and risk factors of high-risk human papillomavirus infections among women attending gynecology clinics in Kano, Northern Nigeria. Bayero Journal of pure and applied sciences, 6(1), 67-71.

[43] De Vuyst, H., Steyaert, S., Van Renterghem, L., Claeys, P., Muchiri, L., Sitati, S., Vansteelandt, S., Quint, W., Kleter, B., Van Marck, E. and Temmerman, M., 2003. Distribution of human papillomavirus in a family planning population in Nairobi, Kenya. Sexually transmitted diseases, pp.137-142.

[44] Salih, M.M., Safi, M.E., Hart, K. et al. Genotypes of human papillomavirus in Sudanese women with cervical pathology. Infect Agents Cancer 5, 26 (2010). https://doi.org/10.1186/1750-9378-5-26.

[45] Didelot-Rousseau, M.N., Nagot, N., Costes-Martineau, V., Valles, X., Ouedraogo, A., Konate, I., Weiss, H.A., Van de Perre, P., Mayaud, P. and Segondy, M., 2006. Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso. British Journal of Cancer, 95(3), pp.355-362.

[46] Leroy V, Ladner J, De Clercq A, Meheus A, Nyiraziraje M, Karita E, Dabis F (1999): Cervical dysplasia and HIV type 1 infection in African pregnant women: a cross-sectional study, Kigali, Rwanda. The Pregnancy and HIV Study Group (EGE). Sex Transm Infect 1999, 75(2):103–106.

[47] Yakub, M. M., Fowotade, A., Anaedobe, C. G., Manga, M. M., Bakare, R. A., & Abimiku, B. A. (2019). Human papillomavirus correlates of high-grade cervical dysplasia among HIV-Infected women at a major treatment center in Nigeria: a cross-sectional study. The Pan African Medical Journal, 33.

[48] Moodley J, Constant D, Hoffman M, Salimo A, Allan B (2009): Human papillomavirus prevalence, viral load, and pre-cancerous lesions of the cervix in women initiating highly active antiretroviral therapy in South Africa: a cross-sectional study. BMC Cancer 2009, 9(1):275.

[49] Blossom DB, Beigi RH, Farrell JJ, Mackay W, Qadadri B, Brown DR, Rwambuya S, Walker CJ, Kambugu FS, Abdul-Karim FW: Human papillomavirus genotypes associated with cervical cytologic abnormalities and HIV infection in Ugandan women. J Med Virol 2007, 79(6):758–765.

[50] Parham GP, Sahasrabuddhe VV, Mwanahamuntu MH, Shepherd BE, Hicks ML, Stringer EM, Vermund SH (2006): Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia. Gynecol Oncol 2006, 103(3):1017–1022.

[51] Akubue AU, Jalal-Eddeen AS, Abdullahi S (2018). An Evaluation of the Integrated Disease Surveillance and Response (IDSR) in Enugu State, Nigeria. Journal of Health, Medicine, and Nursing www.iiste.org ISSN 2422-8419. Vol.48, 2018.

[52] Morhason-Bello Imran O., Kareem Yusuf Olushola, Adewole Isaac F. (2020). Modeling for Predictors of Knowledge Score on Etiology and Prevention Strategies for Cervical Cancer Among Women of Reproductive Age in Ibadan. JCO Global Oncology. 2020; (6): 892.