Factors associated with late-stage presentation of cervical cancer in Ghana.

OBJECTIVE

To explore factors associated with late clinical presentation among Ghanaian women with cervical cancer.

DESIGN

This is a cross-sectional survey using a paper questionnaire.

SETTING

Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.

PARTICIPANTS

Participants were women presenting for cervical cancer care at KATH. Inclusion criteria were histologically diagnosed cervical cancer and age ≥18 years. The exclusion criteria was age <18. All women presenting from August 2018-August 2019 were recruited.

MAIN OUTCOME MEASURES

The primary outcome was the proportion of participants presenting with late-stage cervical cancer, defined as stage II or higher.

RESULTS

Of 351 total participants, 33.6% were unemployed, 35.3% had no formal education, and 96.6% had an average monthly income of less than five hundred Ghana cedis ($86 USD). Time from symptoms to seeing a doctor ranged from fewer than two weeks (16.0%) to more than twelve months (8.6%). Participants' most common barrier in seeking healthcare was financial constraints (50.0%). Most participants presented at late-stage cervical cancer (95.2%, n=334), with only 4.8% (n=17) presenting at stage I. Of participants presenting with late-stage cervical cancer, the vast majority had never had a Papanicolaou (Pap) smear (99.1%) nor a recent gynecologic exam (99.3%). After adjusting for age, parity, and distance to a healthcare facility, a late-stage presentation was associated with lower income and living in a rural area.

CONCLUSIONS

In Ghana, 95% of women with cervical cancer seek care at a late clinical stage, defined as stage II or greater, when the cancer is inoperable.

FUNDING

None declared.