Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
Research Centre for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Cancer Epidemiol Biomarkers Prev. 2024 Aug 1;33(8):1046-1056. doi: 10.1158/1055-9965.EPI-24-0037.
Cervical cancer presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing cervical cancer screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of cervical cancer among Nepalese women.
Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (World Health Organization STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30 to 69 years, were used. Respondents were asked if they had undergone cervical cancer testing through visual inspection with acetic acid, Pap smear, or human papillomavirus test ever or in the past 5 years. The slope index of inequality (SII) and relative concentration index were used to measure socioeconomic and education-based disparities in cervical cancer test uptake.
Only 7.1% [95% confidence interval (CI): 5.1-9.9] Nepalese women had ever undergone cervical cancer testing, whereas 5.1% (95% CI: 3.4-7.5) tested within the last 5 years. The ever uptake of cervical cancer testing was 5.1 percentage points higher (SII: 5.1, 95% CI: -0.1 to 10.2) among women from the richest compared with the poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8-21.9).
Less than one in ten women in Nepal had a cervical cancer testing, primarily favoring higher educated and wealthier individuals.
Targeted early detection and cervical cancer screening interventions are necessary to address these disparities and improve access and uptake.
在南亚，尤其是在尼泊尔，宫颈癌仍然是一个巨大的挑战，因为那里的筛查仍然有限。过去在尼泊尔进行的研究缺乏全国代表性，也没有深入探讨影响宫颈癌筛查的因素，如教育和社会经济方面的差异。本研究旨在衡量这些差距，并确定尼泊尔妇女进行宫颈癌早期检测的相关因素。
本研究使用了 2019 年尼泊尔非传染性疾病危险因素调查（世界卫生组织 STEP 式非传染性疾病危险因素监测方法）的数据，涉及 2332 名年龄在 30 至 69 岁的妇女。受访者被问到她们是否曾经或在过去 5 年内接受过醋酸视觉检查、巴氏涂片检查或人乳头瘤病毒检查等宫颈癌检查。使用不平等斜率指数（SII）和相对集中指数来衡量宫颈癌检测率的社会经济和教育差异。
仅有 7.1%（95%可信区间：5.1-9.9）的尼泊尔妇女曾接受过宫颈癌检查，而在过去 5 年内接受过检查的妇女仅占 5.1%（95%可信区间：3.4-7.5）。与最贫困家庭相比，最富有家庭的妇女进行宫颈癌检测的比例高出 5.1 个百分点（SII：5.1，95%可信区间：-0.1 至 10.2）。基于教育的差异尤其明显，受过高等教育的城市居民与未受教育的居民之间存在 13.9 个百分点的差异（SII：13.9，95%可信区间：5.8-21.9）。
尼泊尔不到十分之一的妇女接受了宫颈癌检查，主要是受教育程度较高和较富裕的人。
有必要采取有针对性的早期检测和宫颈癌筛查干预措施，以解决这些差异，改善获得和接受程度。
