Delays in reporting of cancer cervix in rural India: sociodemographic and reproductive correlation

Varsha L. Deshmukh, Archana D. Rathod


Background: Cervical cancer, caused by sexually-acquired infection with human papillomavirus (HPV), continues to be a public health problem worldwide as it claims the lives of more than 270,000 women every year. The majority of cervical cancer deaths (85%) occur in women living in low- and middle-income countries. Assessment of socio-demographic profile and reproductive history gives a better picture of the determinants of cervical carcinoma in low-resource settings.

Methods: This hospital-based cross-sectional study was undertaken at a Regional Cancer Institute at Aurangabad, India. Hundred newly diagnosed women with advanced cervical cancer (stage 2B-4B), who were undertaking radiotherapy and/or chemotherapy, were included to assess their socio-demographic, reproductive and clinical profile. The causes for late presentations were also noted.

Results: The mean age of women at the time of detection of cervical cancer was 57.35 years (30-82 years). More than 81% of patients were illiterate and belonged to low socioeconomic status. 47% of the study subjects had their first sexual experience before 15 years of age. Nearly 78% women had 5 or more pregnancies, among them, unusual discharge from vagina (39%) followed by bleeding after menopause (28%) and pain in abdomen (13%) were the most common presenting complaints. The average duration of symptoms was (28 days), time interval between the symptoms and biopsy was (3.6 months). Combination of radiotherapy and chemotherapy was the most common modality of treatment. Most common cause of delay in diagnosis was lack of awareness about the symptom of cancer (11%), feeling ashamed (10%), no one paid attention (19%), not diagnosed and referred at periphery and financial causes (23%) were found.

Conclusions: Prevention of cervical cancer include delaying the age at initiation of sexual activity to above 18 years, spreading cancer awareness in women and with well-equipped health workers with diagnosis and knowledge of cancer cervix. This can prevent the medical and patient delay in the diagnosis of cancer cervix.


Cancer cervix, Causes of delay, Social-demography

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Maria ES, Lynne G, Paul DB. Cervical cancer screening in developing countries. Prim Care Update Ob/Gyn. 2000;7:1.

WHO. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Available at

Rai A, Pradhan S, Mishra CP, Kumar A, Singh TB. Health beliefs of women suffering from cancer: a hospital based study. Ind J Prev Soc Med. 2014;45(1-2):66-72.

Das S, Patro KC. Cancer care in the rural areas of India: a firsthand experience of a clinical oncologist and review of literatures. J Cancer Res Ther. 2010;6:299-303.

Li S, Hu T, Lv W. Changes in prevalence and clinical characteristics of cervical cancer in the Peoples Republic of China: a study of 10012 cases from a nationwide working group. Oncol. 2013;18(10):110189.

Shastri SS, Mittra I, Mishra GA, Gupta S, Dikshit R, Singh S, Badwe RA. Effect of VIA screening by primary health workers: randomized controlled study in Mumbai. India J Nat Cancer Inst. 2014;106(3):dju009.

American Cancer Society. Cervical cancer prevention and early detection. Available at Accessed December2, 2014

Bhurqri Y, Nazir K, Shaheen Y, Usman A, Faridi N, Bhurgri H, et al. Patho-epidemiology of cancer cervix in Karachi. South Asian Pac J Cancer Prev. 2007;8(3):357-62.

Rajarao P, Kumar HB. Study of socio demographic profile of cancer cervix patients in tertiary care hospital, Karimnagar, Andhra Pradesh. Int J Biol Med Res. 2012;3(4):2306-10.

Shastri A, Shastri SS. Cancer screening and prevention in low-resource settings. Nat Rev Cancer 2014;14:822-9.

Andersen R, Vedsted P, Olesen F. Patient delay in cancer studies: a discussion of methods and measures. BMC Serv Res. 2009;9(1):189.

Qiao YL. Perspective of cervical cancer prevention and control in developing countries and areas. Chin J Cancer. 2010 Jan;29(1):1-3.

Visual inspection with acetic acid for cervical cancer screening: test qualities in a primary care setting. University of Zimbabwe/ JHPIEGO Project. Lancet. 1999;353:869-73.

Mayor S. A Quarter of patients with cancer see their GP several times before being referred. 2011 Nov 23;343:d7601.

Ecert L. WHO position on cervical cancer prevention in developing countries. HPV Today. 2009;19.

Okeke T, Onah H, Ikeako LC. The frequency and pattern of female genital tract malignancies at the University Teaching Hospital, Enugu, Nigeria. Ann Med Health Sci Res.2013;3(3):345-8.

WHO. Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy. A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia. WHO. 2012.

Cervical Cancer Incidence Statistics: Cancer research UK, 2013. Available at

Moyer VA. Screening for cervical cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2012;156:880-91.

Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385-94.

WHO guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and women. WHO. 2013:2.

Mishra GA, Pimple SA, Shastri SS. Prevention of Cervix Cancer in India. Oncol. 2016;91(1):1-7.