Background: Organized cervical cancer screening program has contributed to the reduction in incidence of cervical cancer in developed countries. Follow up, to ensure adherence to regular screenings, still poses challenges in poor resource settings. Objective: This study aims at determining the cervical cancer screening uptake, adherence to follow up instructions and interval cervical cancer screening and intervention to improve adherence through personalized reminders (phone calls and text messages). Methods: This was a prospective study of clients screened for cervical cancer at the University of Nigeria Teaching Hospital, Enugu from January 2012 to December 2016. The participants were studied for adherence to interval follow-up screening. Eligible participants were followed up using phone calls and text messages and the outcome noted. The data was analysed using statistical software for social sciences (SPSS) version 17. Results: The mean age and parity of 1146 participants screened for cervical intra-epithelial abnormalities within the study period was 44.18 ± 11.08 years and 3.78 ± 2.08 respectively. Most of the subjects (91.8%) screened negative to squamous intra-epithelial lesion (SIL) or malignancy, 8.2% (94/1146) had various grades of SIL. Thirty-five (37%), 29 (31%), 16 (17%) and 14 (15%) of the 94 SIL positive cases had atypical cells of unknown significance (ASCUS), low-grade squamous intra-epithelial lesion (LGSIL), high-grade squamous intra-epithelial lesion (HGSIL) and cervical carcinoma respectively. Adherence to instructions for repeat cytology was only 37.7% while that for 3 yearly interval rescreening was 17.5%. Phone calls and messages to clients improved adherence to appreciable extent. Conclusion: Adherence to interval and follow-up screening for cervical cancer was low. The use of phone calls and short message services (SMS) to remind clients of screening appointments increased adherence and should be employed in developing countries.
References
[1]
Ajah, L.O., Ezeonu, Iyoke, C.A., Nkwo, P.O. and Ajah, M.I. (2015) A Five Year Review of Cervical Cytology in Abakaliki, Nigeria. American Journal of Cancer Prevention, 3, 23-26.
[2]
Akinfolarin, A.C., Olusegun, A.K., Omoladun, O., Omoniyi-Esan, G.O. and Onwundiegu, U. (2017) Age and Pattern of Pap Smear Abnormalities: Implications for Cervical Cancer Control in a Developing Country. Journal of Cytology, 34, 208-211. https://doi.org/10.4103/JOC.JOC_199_15
[3]
Mbamara, S.U., Ukah, C.O., Onyiaorah, C.I., Ikpeze, O. and Okonkwo, J. (2014) The Pattern of Cervical Cytology in Women Attending Various Clinics at a Tertiary Hospital in Anambra Southeast, Nigeria. British Journal of Medicine and Medical Research, 4, 5218-5228. https://doi.org/10.9734/BJMMR/2014/11345
[4]
Lee, J.K., So, K.A., Piyathilake, C.J. and Kim, M.K. (2013) Mild Obesity, Physical Activity, Calorie Intake, and the Risks of Cervical Intraepithelial Neoplasia and Cervical Cancer. PLoS ONE, 8, e66555. https://doi.org/10.1371/journal.pone.0066555
[5]
Nnadi, D.C., Nwobodo, E.L., Ekele, B.A. and Sahabi, S.M. (2014) Screening for Cervical Cancer: A Review of Outcome among Infertile Women in a Tertiary Hospital in North-West Nigeria. Annals of Medical and Health Science Research, 4, 383-387. https://doi.org/10.4103/2141-9248.133464
[6]
American Society for Colposcopy and Cervical Pathology (ASCCP) (2015) Screening Guidelines 2015.
[7]
World Health Organization (2007) The WHO Strategic Approach to Strengthening Sexual and Reproductive Health Policies and Programmes. WHO, Geneva.
[8]
Onah, H.E., Ezugwu, F.O. and Eze, J.N. (2001) Cervical Cancer Screening: A Survey of Current Practice amongst Nigeria Gynaecologists. Tropical Journal of Obstetrics and Gynaecology, 18, 78-81. https://doi.org/10.4314/tjog.v18i2.14435
[9]
Lieu, D. (1996) The Papanicolaou Smear: Its Value and Limitations. The Journal of Family Practice, 42, 391-399.
[10]
Koss, L.G. (1989) The Papanicolaou Test for Cervical Cancer Detection. A Triumph and a Tragedy. JAMA, 261, 737-743. https://doi.org/10.1001/jama.261.5.737
[11]
Koss, L. (1993) Cervical (Pap) Smear. New Directions. Cancer, 71, 1406-1412. https://doi.org/10.1002/cncr.2820710405
[12]
National Cancer Institute Cancer Screening Consortium for Underserved Women (1995) Breast and Cervical Cancer Screening among Underserved Women. Baseline Survey Results from Six States. Archives of Family Medicine, 4, 617-624. https://doi.org/10.1001/archfami.4.7.617
[13]
Nene, B.M., Deshpande, S., Jayant, K., Budukh, A.M., Dale, P.S., et al. (1996) Early 168 Detection of Cervical Cancer by Visual Inspection: A Population-Based Study in Rural India. International Journal of Cancer, 68, 770-773. https://doi.org/10.1002/(SICI)1097-0215(19961211)68:6<770::AID-IJC14>3.0.CO;2-4
[14]
Dim, C.C., Ezegwui, H.U., Ikeme, A.C., Nwagha, U.I. and 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, 759-762. https://doi.org/10.3109/01443615.2011.598967
[15]
Khanna, N. and Phillips, M.D. (2001) Adherence to Care Plan I Women with Abnormal Papanicolaou Smears: A Review of Barriers and Interventions. The Journal of the American Board of Family Practice, 14, 123-130.
[16]
Schofield, M.J., Sanson-Fisher, R., Halpin, S. and Redman, S. (1994) Notification and Follow-Up of Pap Test Results: Current Practice and Women’s Preferences. Preventive Medicine, 23, 276-283. https://doi.org/10.1006/pmed.1994.1039
[17]
Mitchell, H. and Medley, G. (1989) Adherence to Recommendations for Early Repeat Cervical Smear Tests. BMJ, 298, 1605-1607. https://doi.org/10.1136/bmj.298.6688.1605
[18]
Elwood, J.M., Cotton, R.E., Johnson, J., Jones, G.M., Curnow, J. and Beaver, M.W. (1984) Are Patients with Abnormal Cervical Smears Adequately Managed? British Medical Journal (Clinical Research ed.), 289, 891-894. https://doi.org/10.1136/bmj.289.6449.891
[19]
Ronco, G., Iossa, A., Naldoni, C., et al. (1998) A First Survey of Organized Cervical Cancer Screening Programs in Italy. GISCi Working Group on Organization and Evaluation. Gruppo Italiano Screening Citologico. Tumori, 84, 624-630. https://doi.org/10.1177/030089169808400602
[20]
Agency for Healthcare Research and Quality (2014) Screening for Cervical Cancer. In: Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force, 34. https://www.uspreventiveservicestaskforce.org/
[21]
Miller, S.M., Siejak, K.K., Schroeder, C.M., Lerman, C., Hernandez, E. and Helm, C.W. (1997) Enhancing Adherence Following Abnormal Pap Smears among Low-Income Minority Women: A Preventive Telephone Counseling Strategy. Journal of the National Cancer Institute, 89, 703-708. https://doi.org/10.1093/jnci/89.10.703
[22]
Lerman, C., Hanjani, P., Caputo, C., et al. (1992) Telephone Counseling Improves Adherence to Colposcopy among Lower-Income Minority Women. Journal of Clinical Oncology, 10, 330-333. https://doi.org/10.1200/JCO.1992.10.2.330
[23]
Marcus, A.C., Kaplan, C.P., Crane, L.A., et al. (1998) Reducing Loss-to-Follow-Up among Women with Abnormal Pap Smears. Results from a Randomized Trial Testing an Intensive Follow-Up Protocol and Economic Incentives. Medical Care, 36, 397-410. https://doi.org/10.1097/00005650-199803000-00015
[24]
Enugu State of Nigeria. https://www.britannica.com/place/Enugu-state-Nigeria
[25]
Solomon, D., Davey, D., Kurman, R., Moriarty, A., O’Connor, D., Prey, M., et al. (2002) The 2001 Bethesda System Terminology for Reporting Results of Cervical Cytology. JAMA, 287, 2114-2119. https://doi.org/10.1001/jama.287.16.2114
[26]
Chukwuani, L.I., Onuigbo, W.I.B. and Mgbor, N.C. (2003) Cervical Cancer Screening in Enugu, Nigeria. Tropical Journal of Obstetrics and Gynaecology, 20, 109-112. https://doi.org/10.4314/tjog.v20i2.14412
[27]
Obi, A.N., Ozumba, B.C., Nwokocha, A.R. and Waboso, P.A. (2007) Participation in Highly Subsidised Cervical Cancer Screening by Women in Enugu South-East Nigeria. Journal of Obstetrics and Gynaecology, 27, 305-307. https://doi.org/10.1080/01443610701227976
[28]
Yabroff, K.R., Keener, I.F. and Mandelbratt, J.S. (2000) Effectiveness of Interventions to Improve Follow-Up after Abnormal Cervical Screening. Preventive Medicine, 31, 429-439. https://doi.org/10.1006/pmed.2000.0722
