Reasons why unscreened patients with cervical cancer present with advanced stage disease

Abstract

Objective: Cervical cancer is the most common gynaecological cancer in South Africa, and the vast majority of women present with an advanced stage of the disease. This can be attributed to the absence of an implemented screening programme, resulting in patients becoming symptomatic prior to diagnosis. There are little data on the health-seeking behaviour of these women. The objective was to investigate the circumstances of patients who present with cervical cancer, as well as examine their presenting symptoms and behaviour following the onset of symptoms. Design: Descriptive study. Data were collected from patients who were diagnosed with cervical cancer by means interviews and a questionnaire. Setting and subjects: Women diagnosed and managed with cervical cancer at the Gynaecological Oncology Unit, Kalafong Hospital, Pretoria. Outcomes measured: Included demographic data, tumour characteristics, presenting symptoms, number of visits to and interventions performed at the primary healthcare contact. Results: Eighty-five patients were recruited. Of these, 74% lived in rural areas, 81% had access to primary healthcare facilities and 83% lived close to a healthcare provider. Eight had early-stage disease. The most common presenting symptoms were vaginal bleeding, pain and vaginal discharge. After the onset of symptoms, 55% of patients visited their healthcare provider within four weeks. At the first visit, only 41% of patients had a gynaecological examination and only 15% were appropriately referred, compared to 23% at their second visit. Late presentation was significantly associated with no gynaecological examination (p-value < 0.01). Conclusion: The lack of a cervical cancer screening programme, suboptimal management of symptomatic patients and low levels of literacy and knowledge about cervical cancer and screening are compounding the plight of these patients.