Knowledge of Cervical Cancer, Awareness and Attitude to Screening among Patients at a Cytology Clinic

Research Article

Austin J Obstet Gynecol. 2014;1(1): 4.

Knowledge of Cervical Cancer, Awareness and Attitude to Screening among Patients at a Cytology Clinic

Akinlaja OA1* and Anorlu RI2

1Department of Obstetrics & Gynecology, University of Tennessee, USA

2Department of Obstetrics & Gynecology, Lagos University Teaching Hospital, Nigeria

*Corresponding author: Olukayode A Akinlaja, Department of Obstetrics & Gynecology, University of Tennessee, College of Medicine/ University of Tennessee Health Science Center, USA

Received: June 20, 2014; Accepted: July 21, 2014; Published: July 22, 2014


Objective: Cervical carcinoma is the most common genital cancer in Nigeria and a leading cause of cancer-associated deaths, but the success of large-scale screening programs with the Pap test and the associated reduction in invasive cancer has been well described in developed nations. We determined the level of knowledge of cervical cancer, awareness, and attitude toward the cervical screening program in Lagos.

Methods: Between December 1, 2003, and May 31, 2004, we studied the knowledge, awareness, and attitude of patients at a tertiary institution cytology clinic concerning cervical cancer and screening methods using a self-administered questionnaire.

Results: Of the 255 patients surveyed, data were complete in 238 (93.3%); 112 (47.1%) had heard of cervical cancer, while 94 (39.5%) knew about the Pap test, with health professionals being their most frequent source of information. Fifty-nine (24.9%) had had a prior Pap test, while after counseling on cervical cancer and the screening methods, 213 (89.5%) were ready for routine periodic screening if given the opportunity. Nineteen (8%) would still refuse due to various reasons, and six (2.5%) were not sure. Age and marital status did not influence their knowledge, but the level of education and occupation were found to positively influence their knowledge of cervical cancer and their acceptance of the Pap test.

Conclusion: Adequate health information and counseling on cervical cancer and regular Pap testing still need to be emphasized in developing countries so as to reverse the morbidity and mortality associated with cervical cancer.


Cancer of the cervix is the second most common cancer among women worldwide following breast cancer, accounting for an estimated 530,000 new cancer cases worldwide and for 275,000 deaths in 2008 [1].

It is the commonest gynecological malignancy in Nigeria and a leading cause of cancer associated deaths [2] with an incidence rate of approximately 3% of patients attending the gynecological clinic of the teaching hospital in Lagos [3] but with the aid of screening programs for precancer as well as the availability of HPV vaccination, there has been a 75 percent decrease in the incidence and mortality of cervical cancer over the past 50 years in developed countries [4].

The Pap smear is inexpensive and easily performed but low educational status, prohibitive cost of healthcare, the expense of obtaining and retaining the infrastructure, the technical expertise that are required for cytological screening as well as for tracking women with abnormal test result [5] and the predominance of the etiological factors for cancer of the cervix, have been inimical to its implementation.

Despite there been an increase in centers providing screening over the recent years, it's still not commensurate with the number of patients availing themselves, of their use [6]. This results in patients presenting with advanced disease thereby increasing both the morbidity and mortality and putting undue strain on available health facilities and resources. Our objectives were to determine the awareness of cervical cancer and the screening program at the institution and highlight the role of enlightenment campaigns.

Materials and Methods


A Prospective cross sectional survey was used.


The study was conducted in the cytology clinic of the Lagos university teaching hospital that holds once a week on a Wednesday. Doctors refer patients to the cytology clinics and only few are self-referrals with the bulk of patients being from the gynecological outpatients and postnatal clinics. An average of about 10 patients attend the clinic each day. Cervical smears are routinely taken for cytology and abnormal smears are referred to the gynecology clinic for further investigations and treatment.

Study population

The study involved patients who attended the cytology clinic run by the Obstetrics and Gynecology department of the Lagos University Teaching Hospital between the months of December 2003 and May 2004. A total of 238 patients were seen during this period.

Data collection

The purpose of the study was explained to the patients and verbal consent was obtained before conducting a face-to-face interview using a structured questionnaire administered by the author.

The questionnaire was in three parts; the first part contained the socio-demographic characteristics relating to the age at first intercourse, first and last pregnancies, ethnic background, marital status, place of abode, occupation and educational background. The second related to the knowledge of cervical cancer and the screening programme viz a viz any information the patient might have concerning them and the third part related to the patient's attitude to cervical cancer and the screening programme. This is elicted after some information had been given concerning cervical cancers and the screening programme.


The responses were analysed with descriptive statistics for continous variables and simple percentages for categorical variables using the statistical package SPSS for MS Windows with p<0.005.


The age range of the participants was between 18 and 65 years with a mean of 33.87years. The peak age of attendees was between 30 and 39 years.

The parity distribution revealed a pattern of between 0 and 11 children with 90.3% having less than 5 children and the mean parity was 2.23.

84.2% were married with 12.7% single but sexually active. 82% of patients had education to at least the secondary school level while only 3.8% had no formal education with 55.5% of patients being traders, unemployed or housewives while only 18.1% were professionals. The socio-demographic characteristics are highlighted in Table 1.