Evaluation of coverage and barriers to cervical cancer screening in Armenia
Vahe Ter-Minasyan1,*, Vadim Frolov2, Gagik Bazikyan1, Ara Drampyan1, Hripsime Mokatsyan1, Diana Andreasyan1, Vahan Manvelyan1, Hayk Melkumyan
¹ National Institute of Health (Yerevan, Armenia)
² “Astghik” Medical Center (Yerevan, Armenia)
Abstract
Introduction. Early detection through screening and treatment of precancerous cervical cancer lesions (PCCL) remains the best possible protection against cervical cancer, with 75% incidence reduction in developing countries. In 2015 year, Armenia launched a National screening program for women aged 30–60 years aimed to decrease cervical cancer (CC) morbidity and mortality. It set a goal achieving 50% screening coverage in women aged 30–60 years by 2021. However, 328,881 people were involved in the program, which was 21% of women in Armenia for the specified period, and less than 45% of the age-standardized (targeted) population.
This study aimed to verify and analyze the barriers and obstacles influencing individuals’ decision to participate in a survey-based appropriate prospective screening program.
Materials and methods. The determined representative sample included 601 women aged 30-60 years. Based on the selection criteria 119 individuals were excluded due to being screened previously and only 482 females took part in the survey. The questions of survey were divided into 3 groups (related to the barriers): related to psychological factors, knowledge related and related to physicians. The adopted questionnaire consisted of two parts. The first part was to verify the social-demographic characteristics of respondents (eleven criteria, including age, education level, area of residency, employment status, marital status and number of children in the family, health insurance coverage, self-estimated health status, family history of CC). The second part aimed to reveal the participant’s relation and kind of barriers to CC screening Program. Total amount of questions in both domains was 35 questions.
Results. The obtained data has revealed the significant influence of knowledge-related and physician-related barriers upon rural residence while the urban residents have mentioned mainly psychological barriers. The knowledge related barriers were indicated mostly by respondents with unclear CC family history and those with university degree. The insured respondents mentioned the physician related barrier while psychological barriers were mostly revealed in non-insured patients . The differences were statistically significant (p=.023, p=.025, p=.023 and p=.00867 respectively for residence area, education level, insurance status and family history of CC).
Conclusion. The conducted study demonstrated the significant rates of the knowledge-related and physician-related barriers to screening of CC could have been the potential cause of poor uptake in the 2015-2021 screening program. Strong interconnection exists between barriers to screening and residence area, family history of CC, insurance and level of education. The significant difference in rates of barrier types were revealed in these data categories. The reported high rates of knowledge and physician related barriers to Screening Program compose an alarming evidence. It can potentially become a significant obstacle for reaching the WHO indicated target of 70% screening coverage as the CC elimination measure in developing countries.
Keywords։ HPV, vaccination, papillomavirus, efficacy, safety