Factors influencing cervical cancer re-screening in sub-Saharan Africa: a cohort study

Abstract

Abstract Background - Screening participation at recommended intervals is a crucial component of cervical cancer prevention effectiveness. However, little is known regarding the rate of re-screening in a Sub-Saharan context. Our aim was to estimate the re-screening rate of women in Cameroon after an initial Human Papilloma Virus -based screening and to identify factors that influence adherence. Methods - A cohort study was conducted in the Annex Regional Hospital of Dschang, where a primary screening unit had been implemented in 2015. Participants enrolled in the present study were women who had been screened more than 5 years before the date of inclusion and, for whom a re-screening test for cervical cancer was due. Women who initially tested positive for human papilloma virus (n = 132) and, a random sample of women who tested negative for human papilloma virus (n = 220) were enrolled in the present study. Participants were invited to participate in a telephone survey conducted between October 2021 and March 2022. The survey assessed participation to re-screening or not and reasons for participation or non-participation. Sociodemographic factors were collected, and associations were evaluated using chi-squared tests and logistic regression. Results - A total of 352 participants aged under 50 years (mean age 37.4 years) were contacted, and 203 (58.0%) complete the survey. The proportion of women who complied with the screening recommendation was 34.0% (95% CI 27.5% − 40.5%). Age, marital status, education level, type of employment, and place of residence were not associated with the rate of re-screening. Main reported barriers to re-screening were lack of information (39.0%), forgetfulness (39.0%), and impression of being in good health (30.0%). Women who remembered the recommended screening interval were 2 to 3 times more likely to undergo re-screening (aOR (adjusted odds ratio) = 2.3 [1.2–4.4], p = 0.013). Human papilloma virus- positive status at the initial screening was also associated with the re-screening((aOR) (95% CI): 3.4 (1.8–6.5). Conclusion - Following an initial Human Papilloma Virus-based screening campaign in the West Region of Cameroon, one third of women adhered to re-screening within the recommended timeframe. Existing screening strategies would benefit from developing better information approaches to reinforce the importance of repeated cervical cancer screening.