AWARENESS AND UTILIZATION OF VISUAL INSPECTION WITH ACETIC – ACID FOR CERVICAL CANCER SCREENING BY HEALTH CARE WORKERS IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1         BACKGROUND OF THE STUDY

Cervical cancer is reported to be the second most common and the fifth deadliest disease in women. It affects about 16 per 100,000 women per year and kills about 9 per 100,000 per year. Approximately, 80% of cervical cancer occur in developing countries. Globally, in 2008, it was estimated that there were 473,000 cases of cervical cancer, and 253,500 deaths per year (Dim, 2012).

Moon, Cordoso, Baptista, Mohsin, Sten and Vermund (2012), stated that globally, cervical cancer is the second most common cancer in women with approximately 500,000 new cases and 275,000 deaths per year, of which roughly 85% of the cases occur in low-income countries including Nigeria. Southeast Asia only contributes about 25% of the world total disease burden.

In the United States, it is the 8^th most common disease in women and the incidence of new cases of cervical cancer in the United States was 7 per 100,000 women in 2004, but cervical cancer deaths decreased by approximately 74% in the last 50 years, largely due to wide spread screening programmes (Dim, 2012). In the United Kingdom, the incidence is 8.5/100,000 per year in 2006 with 42% reduction from 1997 – 1998 due to screening procedures, which have been highly successful. In Australia, there were 734 cases of cervical cancer in 2005, and the number of women diagnosed with cervical cancer has dropped on average by 4.5% each year since organized screening began in 2005.

The World Health Organization (2006) reported that over the past few decades, 60% of all deaths worldwide has been from chronic non-communicable diseases like cardiovascular diseases,

cancer, chronic respiratory diseases and diabetes.  Mortality due to communicable diseases has 1

decreased, while there is an increase in that of cancer and heart diseases. The cervical cancer incidence remains unchanged with about 44% overall survival rate or about 10 per 100,000 women dying from the disease over an average of 5 years (WHO, 2006).

According to a report of Alliance for Cervical Cancer Prevention (ACCP) (2004), the regions hardest hit by cervical cancer are among the world poorest regions which are in Central and South America, the Caribbean, sub-Saharan Africa and parts of Asia. Ferley, Bray, Pisani and Parkin (2002) earlier stated that approximately 1.4 million women worldwide are living with cervical cancer, up to 7 million women worldwide may have precancerous condition that needs to be identified and treated early.

In Nigeria, estimated incidence rate of cervical cancer is 25 out of 100,000 women with estimated 8000 new cases diagnosed each year (Adewole, Benedict, Brain and Follen, 2005). Equally, high rate of cervical cancer has been reported from several African countries including Uganda, Malawi, Ethiopia and Kenya (WHO, 2012).

Cervical cancer is a malignant neoplasm arising from cells originating in the cervix uteri. The cervix is the narrow portion of the uterus where it joins with the top of the vagina, and most cervical cancers are squamous cell carcinomas, arising in squamous (flattened) epithelial cells that lie in the cervix. One of the most common symptoms of cervical cancer is abnormal vaginal bleeding but in some cases, there may be no obvious symptoms until the cancer has progressed to an advanced stage (Dim, 2012).

Lauca (2003) earlier stated that Human Papilloma Virus (HPV) infection appears to be a factor in the development of almost all cases of cervical cancer. Usually, women contact HPV between their late teenage and early 30s, with peak infection, coinciding with the onset of sexual activity.

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He stressed that most often, cervical cancer is found much often at age of 40, with peak incidence around age of 43 and peak mortality in the late 50s. There is typically a long delay period between the gaining entrance of the organism (infection) and the invasive cancer stage, making screening programmes to be effective.

In developed countries, the use of cytology screening has strongly reduced both cervical cancer incidence and mortality. Due to lack of technical skills, human resources and financing required, to maintain the screening procedure in developing countries, Nigeria inclusive, the need for visual inspection with acetic acid emerged as immediate help. (Basu, Sankanarayanan, Mandal, Roy, Das, Choudhury, Data, Karamakar, Tsu,Chakrabarti, and Siddiqi, 2002).

Cancer of the cervix is a preventable disease, and its prevention is through early detection of premalignant stages of the disease. In recent years, a screening test for cervical precancerous stage using visual inspection aided by acetic acid has been found to be a suitable low cost and a most feasible alternative modality for control of cervical cancer in developing countries (Basu et al., 2002). Visual inspection of the cervix with acetic acid (VIA) involves the inspection of the cervix with naked eye before and after application of 3-5% acetic acid solution with the use of a light source (Dim, 2012). A study conducted by Belinsan, Quao, Pretomus, Zhong, Elson, Li, Pan, Fischer, Lorincz, and Zahniser (2001) in far away rural China on 1,997 women, found that VIA had a 71% sensitivity and 74% specificity. Sankaranarayanon, Esmy and Rajkumar (2007) supported the position by stating that visual inspection with acetic acid (VIA) can be an effective and acceptable method of cervical cancer screening in developing countries like Nigeria. McCarey, Pirek, Tebeu, Boulvain, Doh and Patrick (2011) further stated that creating awareness among health workers on risk factors and current methods for cervical cancer screening is necessary and good step towards implementing effective prevention programs.