Implementing visual cervical cancer screening in Senegal: a cross-sectional study of risk factors and prevalence highlighting service utilization barriers

J Andrew Dykens, Annē M Linn, Tracy Irwin, Karen E Peters, Maria Pyra, Fatoumata Traoré, Mariama Touré Diarra, Memoona Hasnain, Katie Wallner, Patrick Linn, Youssoupha Ndiaye, J Andrew Dykens, Annē M Linn, Tracy Irwin, Karen E Peters, Maria Pyra, Fatoumata Traoré, Mariama Touré Diarra, Memoona Hasnain, Katie Wallner, Patrick Linn, Youssoupha Ndiaye

Abstract

Background: Senegal ranks 15th in the world in incidence of cervical cancer, the number one cause of cancer mortality among women in this country. The estimated participation rate for cervical cancer screening throughout Senegal is very low (6.9% of women 18-69 years old), especially in rural areas and among older age groups (only 1.9% of women above the age of 40 years). There are no reliable estimates of the prevalence of cervical dysplasia or risk factors for cervical dysplasia specific to rural Senegal. The goals of this study were to estimate the prevalence of cervical dysplasia in a rural region using visual inspection of the cervix with acetic acid (VIA) and to assess risk factors for cervical cancer control.

Patients and methods: We conducted a cross-sectional study in which we randomly selected 38 villages across the Kédougou region using a three-stage clustering process. Between October 2013 and March 2014, we collected VIA screening results for women aged 30-50 years and cervical cancer risk factors linked to the screening result.

Results: We screened 509 women; 5.6% of the estimated target population (9,041) in the region. The point prevalence of cervical dysplasia (positive VIA test) was 2.10% (95% confidence interval [CI]: 0.99-3.21). Moreover, 287 women completed the cervical cancer risk factor survey (56.4% response rate) and only 38% stated awareness of cervical cancer; 75.9% of the screened women were less than 40 years of age.

Conclusion: The overall prevalence of dysplasia in this sample was lower than anticipated. Despite both overall awareness and screening uptake being less than expected, our study highlights the need to address challenges in future prevalence estimates. Principally, we identified that the highest-risk women are the ones least likely to seek screening services, thus illustrating a need to fully understand demand-side barriers to accessing health services in this population. Targeted efforts to educate and motivate older women to seek screenings are needed to sustain an effective cervical cancer screening program.

Keywords: cervical cancer screening; global health; gynecologic cancer; implementation; risk factors; visual inspection of the cervix with acetic acid.

Conflict of interest statement

There exist no relevant conflicts of interest in the form of financial interest for any author. No authors hold any patents broadly relevant to this work. A potential perceived conflict of interest based on a relationship is that J Andrew Dykens directs a 501(c)(3) nonprofit organization, Peace Care, which is partially responsible for the development of the partnership between the implicated institutions. Dr Dykens has never been and is not currently compensated in any way for his role with Peace Care. Furthermore, Peace Care has not contributed financially to any aspect of the science or research within this partnership. The role of Peace Care is limited to the partnership development and management. The authors report no other conflicts of interest in this work.

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