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Cited by 190Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

Lifetime Prevalence of Cervical Cancer Screening in 55 Low- and Middle-Income Countries

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Lemp, Julia M., De Neve, Jan-Walter, Bussmann, Hermann, Chen, Simiao, Manne-Goehler, Jennifer, Theilmann, Michaela, Marcus, Maja-Emilia, Ebert, Cara +17 more·2020·JAMA
DOI 10.1001/jama.2020.16244PMC PMC7576410
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Abstract

Importance: The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. Objective: To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries. Design, Setting, and Participants: Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening. Exposures: World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics. Main Outcomes and Measures: Self-report of having ever had a screening test for cervical cancer. Results: Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened. Conclusions and Relevance: In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening.

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  • Women face many cultural, emotional, functional, social, religious, geographical and economic barriers to receiving Pap smear services, including lack of knowledge, lack of doctor's advice, stress, embarrassment, high cost, busy work, lack of privacy, fear of positive test result, and aggressiveness of follow-up procedures.

    “Among the reasons for not adhering to this test are lack of knowledge about the need for Pap smear, lack of doctor’s advice, stress, embarrassment caused by the test, high cost, busy work, lack of privacy, fear of the positive test result, aggressiveness of the follow-up procedures (if the test turns positive) [11–13].”

    From Effectiveness of educational intervention on women’s participation to cervical cancer screening: a quasi-experimental study based on PEN-3 model (2022) · cites this paper as [13]

    The Discussion (page not provided) suggests that cultural and societal values influence access to screening and mentions free screening as a possible contributor to higher uptake. The Limitations section also notes low awareness of screening recommendations and that screening is generally perceived as uncomfortable. The paper does not establish the citing sentence’s detailed list of reasons for not obtaining a Pap smear, including lack of doctor’s advice, busy work, lack of privacy, fear of a positive result, or aggressive follow-up procedures. (LLM, conf=0.83)

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  1. The American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 9th edition. AAPOR. https://www.aapor.org/AAPOR_Main/media/publications/Standard- Definitions20169theditionfinal.pdf. Published 2016. Accessed April 14, 2020.
  2. Teller Road, Thousand Oaks California 91320 United States of America: Sage Publications, Inc. doi:10.4135/9781412963947.n537 · DOI

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Authors
Lemp, J. M., De Neve, J.-W., Bussmann, H., Chen, S., Manne-Goehler, J., Theilmann, M., Marcus, M.-E., Ebert, C., Probst, C., Tsabedze-Sibanyoni, L., Sturua, L., Kibachio, J. M., Moghaddam, S. S., Martins, J. S., Houinato, D., Houehanou, C., Gurung, M. S., Gathecha, G., Farzadfar, F., Dryden-Peterson, S., Davies, J. I., Atun, R., Vollmer, S., Bärnighausen, T., & Geldsetzer, P.
Affiliations
  • Heidelberg University (DE)
  • Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
  • University Hospital Heidelberg (DE)
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
  • University of Göttingen (DE)
  • RWI – Leibniz Institute for Economic Research (DE)
  • Centre for Addiction and Mental Health (CA)
  • Eswatini Ministry of Health, Mbabane, Eswatini
  • National Center for Disease Control and Public Health (GE)
  • University of Geneva (CH)
  • Endocrinology and Metabolism Clinical Sciences Institute (IR)
  • Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa’e, Rua Jacinto Candido, Dili, Timor-Leste
  • Université d'Abomey-Calavi (BJ)
  • Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
  • Ministry of Health (BT)
  • Ministry of Health (KE)
  • Endocrinology and Metabolism Population Sciences Institute (IR)
  • University of the Witwatersrand (ZA)
  • Harvard University (US)
  • Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
Corresponding author
Geldsetzer, Pascal
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2020-10-20
Volume
324
Issue
15
Pages
1532
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2020.16244
PMC
PMC7576410
OpenAlex
W3092675651
Cited by
190
References
33
Citations by year
2026: 22 · 2025: 37 · 2024: 44 · 2023: 32 · 2022: 33 · 2021: 22
FWCI
15.60
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • JAMA (publishedVersion, public-domain)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Funders
  • Wellcome Trust
  • National Institutes of Health (KL2TR003143)
  • National Institute on Aging (R01AG034479, R21AG034263, P01AG041710)
  • National Cancer Institute (R01CA236546)
  • National Institute of Allergy and Infectious Diseases (R01AI112339, T32AI007433)
  • Fogarty International Center (D43TW009775)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
cervical cancer screening, low- and middle-income countries, health equity, urban-rural differences, educational attainment, household wealth, Latin America and the Caribbean, sub-Saharan Africa, health system characteristics, gross domestic product, health care costs, women's health disparities
MeSH terms
Adult, Uterine Cervical Neoplasms, Cross-Sectional Studies, Developing Countries, Female, Humans, Middle Aged, Patient Acceptance of Health Care, Global Health, Health Care Surveys, Early Detection of Cancer, Self Report

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