Predictors of early presentation for cancer of the cervix patients at Uganda Cancer Institute and Kawempe national Refferal hospital: a case control study.

Abstract

Introduction: Over 570,000 new cases of cancer of the cervix and 311,000 occur annually worldwide. In Uganda over 6000 are diagnosed annually, however only 20% of these women are diagnosed with early stage cervical cancer. Detecting cervical cancer in the early stage presents an opportunity for successful treatment of the cancerous lesions. The stage (early vs late stage) at which women present to the health care provider is influenced a by various factors. Objective: To determine the predictors of early presentation among women with cervical cancer at Uganda cancer institute and Kawempe national referral hospital. Methods: This study employed a case control study design. Cases (n=72) were women who presented with early stage disease. While controls (n= 211) were those who presented with late stage disease. Informed consent was obtained and data collection was done using interviewer administered questionnaires. Data was double entered into Epidata version 4.2 and analyzed using STATA version 14 at univariate using descriptive statistics then at bivariate and multivariate levels using logistic regression at 5% level of significance with early presentation as an outcome. Results There were 72 cases and 211 controls (1 case: 3 controls, N=283). Majority of the women (69.3%) were above 40 years at the time of diagnosis. More than half of them were married (55.5%), and had no or primary level education (52.1%); while 56.7% of them were either professionals or businesswomen. The odds of early presentation were higher among younger age groups of women that is women 40 years and below, and those 41- 60 years; when compared to those greater than 60 years; Adjusted Odds Ratio (AOR) 3.17 95% CI (1.09-9.15) for 41-60 years, and Adjusted Odds Ratio (AOR) 3.82 95% CI for those 40 years and younger. Secondly, women who had secondary or tertiary level education, when compared to those with primary or no education; had two times higher odds of presenting early Adjusted Odds Ratio (AOR) 2.16 95% CI (1.19-3.91). Women who had six months and less time from onset of symptoms to diagnosis of cervical cancer, had higher odds of early diagnosis compared to those with more than 12 months from onset of symptoms to diagnosis. That is, Adjusted Odds Ratio (AOR) 3.75 95% CI (1.44-9.79) for those who had three to six months from onset of symptoms to diagnosis, and Adjusted Odds Ratio 2.88 95% CI (1.17-7.13) for those who had less than three months from onset of symptoms to diagnosis. Additionally, women who perceived initial symptoms as serious had 2.4 times higher odds of early presentation, Adjusted Odds Ratio (AOR) 2.4 95% CI (1.28-4.49), as compared to those who perceived initial symptoms as mild or who did not know Conclusion and Recommendations Factors associated with early presentation of women with cervical cancer, were age at diagnosis, education level of the women, time from onset of symptoms to diagnosis of cervical cancer, and perception of initial symptoms. Hence there should be increased information, education and communication to the public about cervical cancer. Awareness campaigns should put emphasis on older women above 60 years, especially in rural areas where most elderly women stay and also encourage and promote girl’s education up to secondary and tertiary level. Utility of the findings: The results from this study will provide baseline information for the development of strategies to diagnose and treat cervical cancer early.