Yerramilli Pooja, Dugee Otgonduya, Enkhtuya Palam, Knaul Felicia M, Demaio Alessandro R
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Public Health Institute, Ministry of Health of Mongolia, Ulaanbaatar, Mongolia.
Oncologist. 2015 Nov;20(11):1266-73. doi: 10.1634/theoncologist.2015-0119. Epub 2015 Sep 28.
Mongolia bears the second-highest cancer burden in the world (5,214 disability-adjusted life years per 100,000 people, age standardized). To determine drivers of the growing burden of noncommunicable diseases, including breast and cervical cancers, a national knowledge, attitudes, and practices (KAP) survey was implemented in 2010.
This paper analyzed the results of the 2010 KAP survey, which sampled 3,450 households nationally. Reflecting Mongolian screening policies, women aged 30 and older were included in analyses of questions regarding breast and cervical cancer (n = 1,193). Univariate and multivariate odds ratios (MORs) were derived through logistic regression to determine associations between demographic covariables (residence, age, education, employment) and survey responses.
This study found that 25.7% (95% confidence interval [CI]: 23.3-28.3) and 22.1% (95% CI: 19.8-24.5) of female participants aged 30 years or older self-rated their knowledge of breast and cervical cancers, respectively, as "none." Employment and education were associated with greater awareness of both cancers and participation in screening examinations (p < .05). Clinical breast examinations were more common among rural than urban participants (MOR: 1.492; 95% CI: 1.125-1.979). Of all female participants, 17% (95% CI: 15.3-18.5) knew that cervical cancer is vaccine preventable.
Our results suggest that cancer control in Mongolia should emphasize health education, particularly among lower-educated, rural, and unemployed women. The health infrastructure should be strengthened to reflect rural to urban migration. Finally, although there is awareness that early detection improves outcomes, a significant proportion of women do not engage in screening. These trends warrant further research on barriers and solutions.
The rising burden of breast and cervical cancers, particularly in low- and middle-income countries, necessitates the development of effective strategies for cancer control. This paper examines barriers to health service use in Mongolia, a country with a high cancer burden. The 2010 national knowledge, attitude and practices survey data indicate that cancer control efforts should focus on improving health education among lower-educated, rural, and unemployed populations, who display the least knowledge of breast and cervical cancers. Moreover, the findings support the need to emphasize individual risk for disease in cancer education and ensure that the health-care infrastructure reflects Mongolia's urbanization.
蒙古国的癌症负担在世界上排名第二（年龄标准化后，每10万人中有5214个伤残调整生命年）。为了确定包括乳腺癌和宫颈癌在内的非传染性疾病负担不断增加的驱动因素，2010年开展了一项全国性的知识、态度和行为（KAP）调查。
本文分析了2010年KAP调查的结果，该调查在全国范围内对3450户家庭进行了抽样。根据蒙古国的筛查政策，年龄在30岁及以上的女性被纳入有关乳腺癌和宫颈癌问题的分析（n = 1193）。通过逻辑回归得出单变量和多变量比值比（MOR），以确定人口统计学协变量（居住地、年龄、教育程度、就业情况）与调查答复之间的关联。
本研究发现，30岁及以上的女性参与者中，分别有25.7%（95%置信区间[CI]：23.3 - 28.3）和22.1%（95% CI：19.8 - 24.5）将自己对乳腺癌和宫颈癌的知识自评为“一无所知”。就业和教育与对这两种癌症的更高认识以及参与筛查检查相关（p < 0.05）。农村参与者中临床乳腺检查比城市参与者更常见（MOR：1.492；95% CI：1.125 - 1.979）。在所有女性参与者中，17%（95% CI：15.3 - 18.5）知道宫颈癌是可通过疫苗预防的。
我们的结果表明，蒙古国的癌症控制应强调健康教育，特别是在受教育程度较低、农村和失业女性中。应加强卫生基础设施建设以适应农村到城市的人口迁移。最后，尽管人们意识到早期发现可改善治疗结果，但仍有很大比例的女性未参与筛查。这些趋势值得进一步研究障碍和解决办法。
乳腺癌和宫颈癌负担的不断上升，特别是在低收入和中等收入国家，需要制定有效的癌症控制策略。本文研究了癌症负担较高的蒙古国在卫生服务利用方面的障碍。2010年全国知识、态度和行为调查数据表明，癌症控制工作应侧重于提高受教育程度较低、农村和失业人群的健康教育，这些人群对乳腺癌和宫颈癌的了解最少。此外，研究结果支持在癌症教育中强调个体疾病风险的必要性，并确保医疗保健基础设施适应蒙古国的城市化进程。
