Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Obstetric and Gynecological Department/Cervical Cancer Screening and Training Center, Catholic Hospital, Battor, Ghana.
BMC Public Health. 2018 Oct 3;18(1):1156. doi: 10.1186/s12889-018-6065-6.
Cervical cancer is the leading and most common female cancer among women in Ghana. Although there are screening methods to detect premalignant lesions for treatment, screening coverage in Ghana is 2.8% and late presentation of cases complicates treatment efforts. This study examined the sociodemographic, clinical and histological characteristics associated with late presentation of cervical cancer cases attending Gynecological Oncology care at Catholic Hospital, Battor.
One hundred and fifty-seven medical records of confirmed cases of cervical cancer reporting to the Outpatient Obstetrics and Gynecology Department between 2012 and 2016 were reviewed. Relevant data were retrieved using abstraction forms. Socio demographic variables investigated were level of education attained, marital status, National Health Insurance Scheme membership, employment status, place of residence and distance from hospital. Clinical variables included intermenstrual/postmenopausal bleeding, previous screening history, previous smoking history, age at menarche and number of children. Histological variables included subtypes of tumour and characteristics of tumour. Pearson's chi-square test and logistic regression analysis were used to determine correlates of late stage at presentation with cervical cancer. Sensitivity analysis was performed to assess the effect of missing data.
Approximately two-thirds (65.97%) of the cases presented in advanced stages of cervical cancer. Level of education, age at menarche and previous screening history were included in a regression model and adjusted for age. Age at menarche (n = 66) was eliminated from the model after sensitivity analysis. Among the remaining variables, only previous screening history was predictive of late stage at presentation of cervical cancer cases. Previously unscreened cases of cervical cancer were nearly four times more likely to present late, compared to those who had been screened previously (OR 3.91; 95% CI 1.43-10.69). No association was observed with sociodemographic and histological characteristics.
Lack of previous screening was associated with late presentation of cervical cancer at Catholic Hospital, Battor. Efforts to promote early cervical cancer screening should be intensified and future studies may explore an association with age at menarche.
在加纳，宫颈癌是女性中发病率最高、最常见的癌症。虽然有筛查方法可以检测癌前病变进行治疗，但加纳的筛查覆盖率仅为 2.8%，病例的晚期呈现使治疗工作复杂化。本研究调查了与在巴托尔天主教医院妇科肿瘤护理就诊的宫颈癌病例晚期呈现相关的社会人口学、临床和组织学特征。
回顾了 2012 年至 2016 年间在妇产科门诊就诊的 157 例宫颈癌确诊病例的医疗记录。使用摘要表检索了相关数据。调查的社会人口变量包括所受教育程度、婚姻状况、国家健康保险计划成员资格、就业状况、居住地和与医院的距离。临床变量包括月经间/绝经后出血、既往筛查史、既往吸烟史、初潮年龄和子女数量。组织学变量包括肿瘤亚型和肿瘤特征。采用 Pearson 卡方检验和逻辑回归分析确定与宫颈癌晚期呈现相关的因素。进行敏感性分析以评估缺失数据的影响。
大约三分之二（65.97%）的病例呈现为宫颈癌晚期。教育程度、初潮年龄和既往筛查史被纳入回归模型，并根据年龄进行了调整。在敏感性分析后，初潮年龄（n=66）被从模型中删除。在剩余的变量中，只有既往筛查史是预测宫颈癌晚期呈现的因素。与既往筛查过的病例相比，从未筛查过的宫颈癌病例更有可能晚期呈现，风险比为 3.91（95%CI 1.43-10.69）。与社会人口学和组织学特征没有关联。
在巴托尔天主教医院，缺乏既往筛查与宫颈癌的晚期呈现相关。应加强促进早期宫颈癌筛查的努力，未来的研究可能会探讨与初潮年龄的关联。
