Abstract

Background: Cervical cancer imposes a huge global burden. To date, various studies have been conducted on the prevalence and risk factors associated with cervical cancer. The aim of this study was to determine the prevalence and risks factors of cervical cancer among women of reproductive age and evaluate the knowledge of women on cervical cancer and the risks factors associated to the pathology.

Method: This was an analytical cross-sectional study carry out in the Laquintinie Hospital Douala from, February to April, 2021. A questionnaire was used to collect information on socio-demographic profile, social history, knowledge on cervical cancer and risks factors. Samples were collected from the uterus, and smears where made on clean slides for Pap analysis.

Tissues were collected from the uterus of women who showed a positive Pap test for biopsy analysis. Data collected were entered into MS Excel, analysed using SPSS version 20. RESULTS: The prevalence of cervical cancer was 1.48%. The prevalence of CIN was 17 (12.59%), (L-SIL 8.15%, H-SIL 2.22%, AGUS 1.48%, ASCUS 1.48%) while 118

participants had other findings (87.41%), (Inflammatory 17.04%, Candida 14.07%, Gardnerella vaginalis 2.96%). Of the 17 positive cytology results, 9 patients did a biopsy where benign changes accounted for 5.19 %. (CIN 11.48%, Condyloma1.48%, Low grade adenoma1.48%, Endocervical adenocarcinoma usual type 0.74%, poorly differentiated invasive squamous cell carcinoma 0.74%). Risk factors for cervical cancer identified included number of sexual partners, sexual transmitted diseases and family history of cervical cancer. Out of 135 patients screened, 89 had poor knowledge of cervical cancer and 84 had poor knowledge of risk factors of cervical cancer.

Conclusion: The prevalence of precancerous lesions is higher than the prevalence of cervical cancer itself. The high number of positive results obtained from the Pap test is an indication of how useful regular screening will be in the early detection of cervical cancer.

CHAPTER ONE

INTRODUCTION

The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus [1]. Located at the lowermost portion of the uterus, the cervix is composed primarily of fibromuscular tissue. The cervix produces cervical mucus that changes in consistency during the menstrual cycle to prevent or promote pregnancy [1].

The cervix is lined by stratified squamous epithelium that covers the exocervix and mucus‐secreting columnar epithelium characteristic of the endocervical canal [1]. The transition between these 2 populations of  cells is called the squamocolumnar junction, and it is this area that is believed to be at greatest risk of viral neoplastic transformation [1]. Among all the conditions that can affect the cervix, cervical cancer is one of the prominent.

The majority of cases of cervical cancer result from infection with the human papillomavirus (HPV), with HPV DNA identified in approximately 95% of malignant cervical lesions [1]. HPV is mainly transmitted through sexual contact [2]. Most people are infected with HPV shortly after the onset of sexual activity [3].

Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA, leading to the changes of genes that control the growth and division function of the cells [4]. A cell’s DNA contains the instructions that tell the cell what to do.

Healthy cells will grow  and multiply at a set rate, eventually dying at a set time (apoptosis), but in the case of a cancer, the mutations tell the cells to grow and multiply out of control, and they don’t die [5].

The accumulating abnormal cells form a mass (tumor). Hence cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body [6].

In the early stage no signs can be observed, some complications of cervical cancer are; pelvic pain, kidney failure, blood clot, vaginal bleeding, fistula, vaginal discharge [7]. There are two types of tests involved in the screening of cervical cancer; the Papanicolaou test and the Human Papilloma Virus test. For both tests, cells are collected from the surface of the cervix.

With the Pap test, the sample is checked for cancer cells or abnormal cells that could become cancerous later. With the HPV test the laboratory checks for HPV infection since HPV can sometimes lead to cancer.

This process of screening women against cervical cancer has been shown to decrease the number of women dying from it [8]. Treatment options  include surgery, pharmacotherapy, chemotherapy, radiation therapy, hyperthermia, cryotherapy and laser [9]. Prevention of HPV infection is key to preventing cervical cancer.

In December 2014, the FDA approved Gardasil 9 (9-valent human papillomavirus vaccine [9vHPV]) for the prevention of diseases caused by nine types of HPV: 6, 11, 16, 18, 31, 33, 45, 52, and 58.28, Gardasil 9 is approved for use in females aged 9 to 26 and in males aged 9 to 15[10].

Cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases and 266,000 deaths in 2012, almost nine out of ten (87%) cervical cancer deaths occur in the less-developed regions of the world [11].

Approximately 85% of the worldwide deaths from cervical cancer occur in underdeveloped or developing countries, and the death rate is 18 times higher in low‐income and middle‐income countries compared with wealthier countries [12]. In sub-Saharan Africa, the annual incidence is 34.8 new cases per 100,000 women with annual mortality of 22.5 deaths per 100,000 women [13].

In Cameroon, cervical cancer prevalence was shown to be up to 13.8%, based on a study carried out in the capital city Yaounde [14]. More than 6 million Cameroonian females who are aged 15 and above are at risk of developing cervical cancer [14].

1.1 Rational

Cervical cancer is one of the leading causes of death among women. Deaths due to cervical cancer occur mainly in underdeveloped countries due to the fact that women are not well informed about the condition and the sanitary facilities are not well developed.

Apart from that, lifestyle and practices like; smoking, using birth control pills for a long time (five or more years), having given birth to three or more children, having several sexual partners contribute to the cause of cervical cancer.

Early diagnosis of the cervical cancer can be easily manageable compared to late diagnosis with complications. This study was aimed at determining the “Prevalence and risk factors of cervical cancer among women of reproductive age” so as to generate data of clinico-epidemiological importance.

1.2 Hypothesis

There is a high prevalence of cervical cancer among women aged 15 to 49 years old attending the Laquintinie Hospital Douala for routine screening for cervical cancer.

1.3 Objectives

1.3.1 General Objective

To determine the prevalence and risk factors of cervical cancer among women of reproductive age (15-49 years old) attending the Laquintinie Hospital of Douala.

1.3.2 Specific Objectives;

1. To determine the prevalence of cervical cancer among women of reproductive age attending the Laquintinie Hospital Douala.
2. To determine risk factors associated with cervical cancer among women of reproductive age attending the Laquintinie Hospital Douala.
3. To evaluate women’s knowledge of cervical cancer and risks factors associated with the pathology.

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