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Factors associated with late-stage presentation of cervical cancer in Ghana


Adu Appiah-Kubi
Thomas O. Konney
Kwabena Amo-Antwi
Augustine Tawiah
Maxwell K. Nti
Frank Ankobea-Kokroe
Sarah G. Bell
Priscilla K. Appiah-Kubi
Carolyn Johnston
Emma R. Lawrence

Abstract

Objective: To explore factors associated with late clinical presentation among Ghanaian women with cervical cancer
Design: This is a cross-sectional survey using a paper questionnaire.
Setting: Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.
Participants: Participants were women presenting for cervical cancer care at KATH. Inclusion criteria were histo-logically diagnosed cervical cancer and age ≥18 years. The exclusion criteria was age <18. All women presenting from August 2018-August 2019 were recruited.
Main outcome measures: The primary outcome was the proportion of participants presenting with late-stage cervical cancer, defined as stage II or higher.
Results: Of 351 total participants, 33.6% were unemployed, 35.3% had no formal education, and 96.6% had an aver-age monthly income of less than five hundred Ghana cedis ($86 USD). Time from symptoms to seeing a doctor ranged from fewer than two weeks (16.0%) to more than twelve months (8.6%). Participants’ most common barrier in seeking healthcare was financial constraints (50.0%). Most participants presented at late-stage cervical cancer (95.2%, n=334), with only 4.8% (n=17) presenting at stage I. Of participants presenting with late-stage cervical cancer, the vast major-ity had never had a Papanicolaou (Pap) smear (99.1%) nor a recent gynecologic exam (99.3%). After adjusting for age, parity, and distance to a healthcare facility, a late-stage presentation was associated with lower income and living in a rural area.
Conclusions: In Ghana, 95% of women with cervical cancer seek care at a late clinical stage, defined as stage II or greater, when the cancer is inoperable.


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print ISSN: 0016-9560