|Year : 2020 | Volume
| Issue : 1 | Page : 35-40
Breast and cervical cancer screening: A survey of university employees
Amaka N Ocheke1, Patricia A Agaba2, Samuel R Ohayi3, Malyot S Onche4, Mary Momoh4, Amos O Aje4, Kenneth N Ozoilo5, Emmanuel I Agaba6
1 Department of Obstetrics & Gynaecology, University of Jos, Jos, Plateau State; Department of Obstetrics & Gynaecology, Jos University Teaching Hospital, Nigeria
2 Department of Family Medicine, University of Jos/Jos University Teaching Hospital, Nigeria
3 Department of Pathology, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
4 Department of Obstetrics & Gynaecology, Jos University Teaching Hospital, Nigeria
5 Department of Surgery, University of Jos/Jos University Teaching Hospital, Nigeria
6 Department of Medicine, University of Jos/Jos University Teaching Hospital, Nigeria
|Date of Submission||16-Jul-2019|
|Date of Decision||19-Feb-2020|
|Date of Acceptance||09-Mar-2020|
|Date of Web Publication||20-May-2020|
Amaka N Ocheke
Department of Obstetrics & Gynaecology, University of Jos, Jos, Plateau State
Source of Support: None, Conflict of Interest: None
Background: There is an increasing occurrence of non-communicable diseases worldwide. Among them, breast and cervical cancers are notable among females. These diseases often present late with adverse outcomes. Only early detection offered by screening of disease offers the hope of cure. Hence, we undertook a breast and cervical cancer screening education and exercise among female workers of a university community. Methods and Methods: This was part of a non-communicable disease survey among members of the university community. Structured questionnaires were administered on participants after a talk. Screening was carried out using the Papanicolau test for cervical cancer and clinical breast examination for breast cancer. Results: A total of 210 participants were screened. 42 (10.8%) and 23 (10.8%) had family history of breast cancer and previous breast lump, respectively. Only one participant (0.48%) had a breast lump. Abnormal Pap smear result was present in 59 (30.1%) (Inflammation [59.32%], high grade squamous intraepithelial lesion (HSIL) [10.17%], low grade squamous intraepithelial lesion (LSIL) [6.78%], atypical squamous cell of undetermined significance (ASCUS) [10.17%], Atypical squamous cells- cannot exclude HSIL’ (ASC-H) [11.86%] and atypical glandular cells of undetermined significance (AGUS) [1.69%]). Conclusion: The uptake of screening was low, the yield for cervical anomalies was also low, but a reasonable proportion of the participants had risk factors for breast and cervical cancers and so would benefit from further screening over time.
Keywords: Breast, cancer, cervix, non-communicable diseases, screening, and duration
|How to cite this article:|
Ocheke AN, Agaba PA, Ohayi SR, Onche MS, Momoh M, Aje AO, Ozoilo KN, Agaba EI. Breast and cervical cancer screening: A survey of university employees. J Med Trop 2020;22:35-40
|How to cite this URL:|
Ocheke AN, Agaba PA, Ohayi SR, Onche MS, Momoh M, Aje AO, Ozoilo KN, Agaba EI. Breast and cervical cancer screening: A survey of university employees. J Med Trop [serial online] 2020 [cited 2020 May 31];22:35-40. Available from: http://www.jmedtropics.org/text.asp?2020/22/1/35/284637
| Introduction|| |
Breast and cervical cancer are the leading causes of cancer-related deaths in women in developing countries.,,, This is largely due to late presentation. Only the early detection which screening provides accords the prospect of cure. However, deaths from cancers of the breast and cervix in the developed world have markedly reduced because of availability and uptake of screening services.,,, This gloomy picture of high rates of cancer-related deaths in our environment is partly due to lack of information regarding the cause and prevention of these cancers., Additionally, screening services are not widely available; and even when available they are restricted to the urban areas., A further contributing factor is the limited uptake of these services even when there are available.,, Nwobodo and Malami in their study of female health workers reported poor knowledge and uptake of cervical cancer screening exercises. Similar findings have been reported by other researchers.,, The situation is compounded by the late presentation of our patients., As part of our efforts to create awareness of non-communicable diseases in our environment, we undertook a breast and cervical cancer screening education and exercise among female workers of a University community.
| Methods|| |
This was part of a cross-sectional study of adults aged 18 and above employed in the University of Jos conducted over a 4-month period (February to June 2014) to screen for non-communicable disease (NCD). The study was resident at the University Health Centre and the details have been previously reported.
The female participants of the NCD study were invited to come for breast and cervical screening on different days set aside for this particular exercise.
Those who turned up for screening were counseled on yearly Papanicolaou smear (Pap smear) and shown how to perform breast self-examination. They were then asked to perform the examination on themselves and those who did not do the examinations properly were corrected and then asked to repeat the examination until we were satisfied that the respondents had acquired the appropriate examination skills.
Structured questionnaires were administered to the participants. Information captured in the questionnaire included age, menarche, age at first coital experience, parity and history of previous breast complaints. Other information included whether the respondents have ever had a PAP smear examination and if not, what the reasons were. Clinical breast examination and PAP smears were then performed on the participants. Those found to have any anomalies were referred for appropriate care.
The Human Research and Ethics Committee of the Jos University Teaching Hospital approved the study. All participants gave written informed consent before participation.
Clinical breast examination was performed on all the participants and the findings were noted. The cervix was then carefully inspected on insertion of a Sim’s speculum with the participant lying in the dorsal position. A cervical brush was inserted into the cervix and rotated 3600. The specimen on the brush was thinly spread on a slide which is then immediately immersed alcohol and left for 15 minutes to fix. After fixation, the slides were stained by the Papanicolau staining method made up of haematoxylin, eosin and OG60 stains
The slides were subsequently examined by a pathologist and classified using the Bethesda classification.
Data obtained was analysed using the Epi Info 7 Statistical software (CDC, Atlanta, GA). Mean ± SD was used to describe normally distributed continuous variables and proportions for categorical variables. Median with range was used to describe non-normally distributed continuous variables. The student “t” test was used to compare group means and the Chi-squared test to compare proportions. The Fisher exact test was used when cells contained less than five (5) observations. The non-parametric test, Mann-Whitney U test was used to compare non-normally distributed continuous variables between groups. A P-value < 0.05 was considered significant.
| Results|| |
Characteristics of study participants
Of the 362 women recruited for the NCD study, only 210 (58.0%) presented themselves for screening for breast and cervical cancers. All relevant information was obtained from all the 362 women. The sociodemographic characteristics of the people that defaulted were similar to those that were screened [Table 1]. Of the total women screened, 128(70.7%) were sexually active with 49 (22.0%) having age at sexual debut less than 18 years. The median parity was 4 (0–10) as shown in [Table 1]. Only one participant had ever smoked.
Prevalence of breast and cervical abnormalities
Twenty four women (10.8%) had a family history of breast cancer. Past history of nipple discharge and pain in the breast were present in 13 (5.8%) and 45 (20.2%) women respectively while 23 (10.3%) had had a breast lump before. However, on examination only one subject was found to have a breast lump. No participant was found to have nipple discharge or abnormalities.
Fourteen (6.6%) cervical smear samples were reported to be inadequate. Of the 196 PAP smears that were adequate, 137 (69.9%) were normal while 59 (30.1%) had abnormal findings as shown in [Figure 1]. Inflammatory changes were the most common abnormality found.
|Figure 1: Distribution of abnormal Papinicolau smear among female staff members of the University of Jos screened for non-communicable disease. (AGUS=atypical glandular cells of undetermined significance; ASC-H=Atypical squamous cells- cannot exclude HSIL; ASCUS=atypical squamous cell of undetermined significance; HSIL=high grade squamous intraepithelial lesion; LSIL=low grade squamous intraepithelial lesion)|
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Determinants of cervical smear abnormalities
Age, present sexual activity and early sexual debut did not significantly affect the occurrence of cervical smear abnormalities as seen in [Table 2]. Conversely, higher parity, fewer sexual partners and a history of having done previous PAP smears seemed to contribute significantly to the finding of PAP smear abnormalities on bivariate analysis in our study population as seen in [Table 2]. However, when the variables of parity, number of sexual partners, previous PAP smear and clinically relevant variables were entered into a multiple logistic regression model [Table 3], no variable was independently associated with abnormal PAP smear examination. Only one of the study participants with abnormal PAP smear and none with normal PAP smear had a history of early onset of menarche hence, this variable was not included in the prediction model.
|Table 2: Relationship between sociodemographics and abnormal PAP smear among 196 female staff members of the University of Jos, Nigeria|
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|Table 3: Independent associations of abnormal PAP smear among 196 female staff members of the University of Jos, Nigeria|
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| Discussion|| |
Breast and cervical cancers are the leading causes of cancer-related deaths in women worldwide. Early detection and treatment hold the key to reducing this burden especially in resource-constrained settings like ours. During a cross-sectional study aimed at screening adults employed in the University of Jos for NCDs, the female participants of study were invited for breast and cervical screening as part of the gender-specific NCDs on different days set aside for this particular exercise. We found that uptake of screening for breast and cervical cancers was poor as only slightly over a half of the participants of the general NCD study presented for breast and cervical screening. Secondly, abnormal PAP smears were seen in 30% while we note the rarity of breast disorders in the women studied as only one participant was found to have a breast lump.
Uptake of the screening exercise
Only 58% of the study participants presented themselves for the screening exercise. This was much higher than the uptake of screening reported from other studies which ranged from 2.2%-15%.,, The cervical and breast cancer screening uptake was less than we expected since this was done in a university community and 75% of the women had tertiary level of education. However, studies from Nigeria have shown that educational status, profession, knowledge of cancers and health education do not seem to have any bearing on the uptake of cervical screening services.,,, Reasons found from these studies for poor uptake of cervical and breast cancer screening services include feeling of good health, fear of a positive result and “dislike for the test” among others.,,,
Risk factors for cervical cancer and PAP smear abnormalities
Known risk factors for cervical cancer were present in the women we studied. Early menarche and coitarche, multiple sexual partners and high parity were identified among our respondents as have been shown to exist elsewhere in Nigeria. Despite the presence of some of these risk factors, the majority (70%) had normal PAP smears. Only a few of the participants had LSIL and HSIL.
Our findings confirm those of Pimentel and colleagues who reported a low proportion of abnormal cervical cytology among 410 in three towns in north central Nigeria. The most common abnormal cytology in their series however was ASCUS (42.9%) while LSIL and HSIL were found in 39.3% and 14.3% respectively. Squamous intraepithelial lesions have been identified as precancerous and have been associated with high-risk human papilloma virus DNA.
Complaints of breast pain/discomfort were made by 20% of the study subject which is similar to report by Ozoilo et al. where 25% complained of breast discomfort. However, only one woman was found to have a breast lump (0.48%) while no one was found to have nipple discharge or breast skin changes despite the fact that 10.8% had a family history of breast cancer, 10.3% gave a history of breast lump and 3% gave a history of breast ulcers and nipple discharge in the past.
In the study by Ozoilo et al., 4.96% of study participants were found to have breast lumps and 27.9% of these were subsequently diagnosed to have breast cancer following biopsy. Our finding of breast lump in 0.48% of our study population was significantly lower than 4.96% reported by Ozoilo and associates. This difference could be due to the fact that in addition to clinical breast examination (CBE), ultrasound scan and mammography were also used while in our study, only CBE was used. Additionally, Ozoilo et al. screened a larger population of women (2095 versus 210 women). Our study had some limitations. We studied a highly selected group of women and hence cannot generalize our findings. We relied on CBE for the detection of breast lumps. Though this may have impacted our findings, the use of mammography and breast ultrasound studies are not usually employed in studies of this nature, but produce a higher yield. We were also unable to test the cervical smears for high-risk human papilloma virus DNA which has been found to correlate strongly with squamous intraepithelial lesions. Finally, the women were not screened for HIV and AIDS. Abnormal cytology and indeed HSIL have been found to occur in higher proportions of HIV infected women compared to their HIV uninflected counterparts and have been found to be influenced by the degree of immunosuppression. Despite these limitations, our study was designed to equip women with the required skills for self-breast examination and education on the need for frequent cervical cytology.
In conclusion, the uptake of screening for breast and cervical cancers among this cohort of university employees is low. While it seems that breast abnormalities are relatively rare in this group, a significant proportion had abnormal cervical cytology. Also, the women who did not show up for the screening exercise also had risk factors for developing these cancers like family history of breast cancer, multiple sexual partners, high parity, early menarche, and early sexual debut. Necessary measures are needed to motivate women to uptake screening services for breast and cervical cancers.
Financial support and sponsorship
This study was funded in part by the Tertiary Education Trust Fund of the Federal Government of Nigeria. The authors acknowledge the contribution of the management of the University health centre and the leaders and members of the various associations at the University of Jos for participating in the study. We also appreciate the efforts of the physicians who participated in data collection, and Mr Chime of the Jos University Teaching Hospital for data entry.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]