Knowledge and attitude regarding cervical cancer and its screening among women and its association with socioeconomic status: perspective from Western India

Hitanshi K. Bhuptani; Kalpita S. Shringarpure; Purav T. Shah; Bhavika J. Gangwani; Krupal D. Chudasama; Shreya S. Mittal; Atman B. Soni

doi:10.18203/2394-6040.ijcmph20264077

Authors

Hitanshi K. Bhuptani Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India https://orcid.org/0009-0007-0533-0462
Kalpita S. Shringarpure Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India https://orcid.org/0000-0003-2203-9419
Purav T. Shah Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India https://orcid.org/0009-0005-9187-1059
Bhavika J. Gangwani Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India https://orcid.org/0009-0002-2905-0864
Krupal D. Chudasama Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India https://orcid.org/0009-0001-2446-6038
Shreya S. Mittal Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India https://orcid.org/0009-0004-4757-5298
Atman B. Soni Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India https://orcid.org/0009-0001-3624-0255

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20264077

Keywords:

Cervical cancer, HPV vaccine, India, Knowledge, Pap smear, Socioeconomic status

Abstract

Background: Cervical cancer remains a major yet preventable cause of morbidity and mortality among women in India. Socioeconomic and educational disparities greatly influence awareness and uptake of preventive measures, especially in low and middle income countries, making it important to study their association within this context.

Methods: In this study, a cross-sectional survey was conducted among 380 women aged 25-65 years attending a tertiary care hospital. Data was collected using a structured questionnaire. Knowledge, attitudes, and perceived barriers related to cervical cancer, Pap smear screening, and HPV vaccination were assessed, with knowledge scores classified according to Bloom’s criteria, and associations with socioeconomic status were measured.

Results: Of 380 participants, only 43.42% (165) of participants had heard of cervical cancer. Amongst, just 10.9% demonstrated good knowledge of its risk factors, symptoms, screening, and prevention. Attitude towards prevention was generally positive, with 63.03% of participants willing to undergo Pap smear testing and 64.24% willing to receive free HPV vaccination. Higher socioeconomic status and educational level were significantly associated with greater awareness and higher knowledge scores. Both educational level and knowledge category were associated with more favorable attitudes toward screening and prevention. Major barriers to screening noted were the absence of symptoms or perceived need, embarrassment, and a male doctor.

Conclusions: These findings demonstrate a dire need for targeted health education, improved accessibility of affordable and gender-sensitive screening services, and strengthened initiatives for cervical cancer prevention in order to reduce the morbidity and mortality associated with this disease in Indian women.

References

Taneja N, Chawla B, Awasthi AA, Shrivastav KD, Jaggi VK, Janardhanan R. Knowledge, attitude, and practice on cervical cancer and screening among women in India: a review. Cancer Control. 2021;28:10732748211010799.

World Health Organization. Human papillomavirus (HPV) and cervical cancer, 2019. Available at: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer. Accessed 23 July 2024.

Ramamoorthy T, Kulothungan V, Sathishkumar K, Tomy N, Mohan R, Balan S, et al. Burden of cervical cancer in India: estimates of years of life lost, years lived with disability and disability adjusted life years at national and subnational levels using the National Cancer Registry Programme data. Reprod Heal. 2024;21(1):111.

Tsige AW, Beyene DA. Cervical cancer: Challenges and prevention strategies: A narrative review. Health Sci Rep. 2024;7(6):e2149.

Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018 Oct;143(Suppl 2):22-36.

Myriokefalitaki E, Potdar N, Barnfield L, Davies Q, Moss EL. Cervical cancer still presents symptomatically 20 years after the introduction of a structured national screening programme. Cytopathol. 2016;27(4):229-36.

Kebebew T, Mavhandu-Mudzusi AH, Mosalo A. A cross-sectional assessment of symptom burden among patients with advanced cervical cancer. BMC Palliat Care. 2021;20(1):190.

Woodman CB, Collins SI, Young LS. The natural history of cervical HPV infection: unresolved issues. Nat Rev Cancer. 2007;7(1):11-22.

de Villiers EM, Fauquet C, Broker TR, Bernard HU, zur Hausen H. Classification of papillomaviruses. Virol. 2004 ;324(1):17-27.

Trottier H, Franco EL. The epidemiology of genital human papillomavirus infection. Vaccine. 2006;24(Suppl 1):S1-15.

Mishra R, Bisht D, Gupta M. Primary screening of cervical cancer by Pap smear in women of reproductive age group. J Family Med Prim Care. 2022;11(9):5327-31.

Mishra GA, Pimple SA, Shastri SS. An overview of prevention and early detection of cervical cancers. Indian J Med Paediatr Oncol. 2011;32(3):125-132.

Raychaudhuri S, Mandal S. Current status of knowledge, attitude and practice (KAP) and screening for cervical cancer in countries at different levels of development. Asian Pac J Cancer Prev. 2012;13(9):4221-7.

Sen S, Khan PK, Wadasadawala T, Mohanty SK. Socio-economic and regional variation in breast and cervical cancer screening among Indian women of reproductive age: a study from National Family Health Survey, 2019-21. BMC Cancer. 2022;22(1):1279.

Narayana G, Suchitra MJ, Sunanda G, Ramaiah JD, Kumar BP, Veerabhadrappa KV. Knowledge, attitude, and practice toward cervical cancer among women attending Obstetrics and Gynecology Department: A cross-sectional, hospital-based survey in South India. Indian J Cancer. 2017;54(2):481-7.

Riaz L, Manazir S, Jawed F, Arshad Ali S, Riaz R. Knowledge, perception, and prevention practices related to human papillomavirus-based cervical cancer and its socioeconomic correlates among women in Karachi, Pakistan. Cureus. 2020;12(3).

Subramanian SS, Bhaskarapillai B, Jayakrishnan R. Female cancer screening in India: Results from the National Family Health Survey (NFHS-5) and the way forward. J Family Med Prim Care. 2024;13(10):4552-9.

Gandhi R, Patel A, Patel M, Sojitra SA, Kundal TS, Murugan Y. Cervical cancer prevention among rural women in Gujarat, India: a mixed methods study on risk factors and KAP (Knowledge, Attitude and Practice). Cureus. 2024;16(9):e69169.

Chellapandian P, Myneni S, Ravikumar D, Padmanaban P, James KM, Kunasekaran VM, et al. Knowledge on cervical cancer and perceived barriers to the uptake of HPV vaccination among health professionals. BMC Womens Health. 2021;21(1):65.

Kaundal A, Renjhen P, Sharma S, Prasad S, Marwaha PD, Kaur H. Human papillomavirus vaccine hesitancy and barriers in achieving 100% vaccine coverage: a web-based cross-sectional study. Ann Afr Med. 2025;24(3):591-7.

Javalkar SR, Naveen H, Shalini, Davalgi S, Vidya GS. Socio economic status assessment in India: history and updates for 2024. Int J Comm Med Publ Heal. 2024;11:1369-1377.

Almonte M, Albero G, Molano M, Carcamo C, García PJ, Pérez G. Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine. 2008;26(Suppl 11):L16-36.

Ahlawat P, Batra N, Sharma P, Kumar S, Kumar A. Knowledge and attitude of adolescent girls and their mothers regarding cervical cancer: a community-based cross-sectional study. J Midlife Health. 2018;9(3):145-9.

Pattupara AJ, Dhiman N, Singh A, Chaturvedi J. Knowledge, attitude and practice study on screening of cervical cancer among women visiting a tertiary care center. SOJ Gynecol Obstet Womens Health. 2016;2(2):3.

Agarwal M, Sinha S, Singh G, Singh S, Ahmad S. Attitude and perceived barriers among highly educated women towards cervical cancer screening by pap smear: an online survey. Cureus. 2022;14(8):e28641.