Devarapalli Pradeep, Labani Satyanarayana, Nagarjuna Narayanasetti, Panchal Poonam, Asthana Smita
Department of Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research, Indian Council of Medical Research, I-7, Sector-39, Noida, Uttar Pradesh, India.
Indian J Cancer. 2018 Oct-Dec;55(4):318-326. doi: 10.4103/ijc.IJC_253_18.
Cervical cancer is the second-most common cancer among women in the developing world and approximately 500,000 cases are diagnosed each year. In developed countries, cervical cancer (CCa) accounts for only 3.6% of newly diagnosed cancers.
The present study aims to identify the most effective barriers associated with CCa screening uptake in low and middle-income countries (L and MICs) and aid to adopt effective measures to overcome prevailing barriers to the attainment of CCa uptake in the community.
Health sciences electronic databases like MEDLINE, PubMed, Cochrane library, and Google Scholar were searched for studies published until August 2017. Keywords used for the search were ("cervical cancer screening"), ("barriers"), AND ("low income countries" OR "Middle income countries"). Articles were reviewed and data were extracted by using Mendeley Desktop Software (V-1.17.10). Income-level classification of countries was done as per the World Bank 2017 report. Statistical software like SPSS-V.23 and Medical-V.14 were used for the statistical application.
A total of 31 studies met the inclusion criteria with a total of 25,650 participants. The sample size of the included studies ranged from 97 to 5929 participants. Articles majorly reported data on participants from African region (51.6%) and minimally in the Western Pacific region (3.2%). Sampling methods among studies varied from convenience sampling-12 (39.7%) to consecutive sampling-1 (3.2%). Besides, two studies (6.5%) did not discuss their sampling procedures. It was observed that "Lack of information about CCa and its treatment" (Barrier of lack of knowledge and Awareness); "Embracement or shy" (Psychological Barrier); "Lack of time" (structural Barrier); and "Lack of family support" (Sociocultural and religious barrier) were the most commonly reported among all 22 barriers.
There is a need of policies advancement of CCa screening programs by focusing on aspects of accessibility, affordability, CCa education, and the necessity of screening to improve screening uptake to control the CCa morbidity and mortality rate in L and MIC's.
宫颈癌是发展中国家女性中第二常见的癌症，每年约有50万例被诊断出来。在发达国家，宫颈癌仅占新诊断癌症的3.6%。
本研究旨在确定低收入和中等收入国家（LMICs）中与宫颈癌筛查接受率相关的最有效障碍，并协助采取有效措施克服社区中影响宫颈癌筛查接受率的普遍障碍。
检索了MEDLINE、PubMed、Cochrane图书馆和谷歌学术等健康科学电子数据库，查找截至2017年8月发表的研究。搜索使用的关键词为（“宫颈癌筛查”）、（“障碍”）以及（“低收入国家”或“中等收入国家”）。通过使用Mendeley桌面软件（V-1.17.10）对文章进行审查并提取数据依据世界银行2017年报告对国家进行收入水平分类。使用SPSS-V.23和Medical-V.14等统计软件进行统计应用。
共有31项研究符合纳入标准，共有25650名参与者。纳入研究的样本量从97名到5929名参与者不等。文章主要报告了来自非洲地区参与者的数据（51.6%），而来自西太平洋地区的数据最少（3.2%）。研究中的抽样方法从便利抽样的12项（39.7%）到连续抽样的1项（3.2%）不等。此外，两项研究（6.5%）未讨论其抽样程序。据观察，在所有22种障碍中，“缺乏关于宫颈癌及其治疗的信息”（知识和意识障碍）、“接受或害羞”（心理障碍）、“缺乏时间”（结构障碍）以及“缺乏家庭支持”（社会文化和宗教障碍）是最常被报告的。
需要推进宫颈癌筛查项目的政策，重点关注可及性、可承受性、宫颈癌教育以及筛查的必要性等方面，以提高筛查接受率，控制低收入和中等收入国家的宫颈癌发病率和死亡率。
