Sage Journals: Discover world-class research

Abstract

Background:

Globally, 570,000 cases of cervical cancer and 311,000 deaths from the disease occurred in 2018. Cervical cancer is the fourth most common cancer in women. About 96,922 new cervical cancer cases are diagnosed annually in India.

Objective:

To summarize the knowledge, attitude, and practice toward screening of cervical cancer among health professionals in India.

Materials and methods:

Health sciences electronic databases PubMed and Google Scholar were searched for studies published between 2012 and March 2020. Keywords used for the search were (“CERVICAL CANCER”), (“SCREENING”), (“KNOWLEDGE”), (“ATTITUDE”), (“PRACTICE”), (“HEALTH PROFESSIONALS”), AND (“INDIA”). A total of 22 articles were included in the review based on the eligibility criteria. Statistical software SPSS-V.23 was used for the statistical application.

Results:

A total of 22 studies met the inclusion criteria with total of 6811 health professionals. The age of the study participants ranged from 18 to 60 years. The overall knowledge of cervical cancer among health professionals was 75.15%. The knowledge toward signs and symptoms and risk factors was adequate among health professionals. The knowledge, attitude, and practice toward screening was 86.20%, 85.47%, and 12.70%, respectively.

Conclusion:

The health professionals have optimum level of knowledge of cervical cancer and knowledge of screening of cervical cancer with appropriate attitude toward screening with low uptake of practice toward screening.

Keywords

attitude cervical cancer health professionals India knowledge practice screening

Introduction

Globally, 570,000 cases of cervical cancer and 311,000 deaths from the disease occurred in 2018. Cervical cancer is the fourth most common cancer in women, ranking after breast cancer (2.1 million cases), colorectal cancer (0.8 million), and lung cancer (0.7 million).¹ One in every five women in the world suffering from cervical cancer belongs to India, which has the largest burden of cervical cancer patients in the world.² Unlike many other cancers, cervical cancer occurs early and strikes at the productive period of a woman’s life. The incidence rises at 30–34 years of age and peaks at 55–65 years, with a median age of 38 years (age 21–67 years).³ Estimates suggest that more than 80% of the sexually active women acquire genital HPV by 50 years of age.⁴

In developed countries, incidence and mortality from cervical cancer have been reduced through measures, which include cytological screening and prompt treatment of early cervical lesions.^5,6 Among all malignant tumors, cervical cancer is the one that can be most effectively controlled by organized screening programs.⁷ According to NHFS report, in India, 22% of women have undergone cervical examination, the pattern of cervical examination indicated that the southern region mainly Kerala has the major contribution toward screening followed by the various districts of Maharashtra.⁸ This is one of the main reasons that in India patients are being diagnosed at advanced stages. The main risk factor for development of cervical cancer is infection with human papilloma virus (HPV) types (HPV 16 and HPV 18).⁹ HPV-DNA viral load quantification and integration and E6/E7 expression are promising biomarkers that can predict the progression of lesions to cervical cancer.¹⁰

Population-based screening program utilizing exfoliative cervical cytology, the Pap test, has reduced cervical cancer morbidity and mortality in developed countries.¹¹ In India, both early detection and screening remains a major area of concern to the health workers in the absence of screening facilities coupled with poor literacy and low level of awareness among Indian women.¹²

Healthcare providers play an essential role in imparting knowledge of risk factors and prevention of the disease; therefore, emphasis was laid on them in this review. Awareness about cervical cancer is the basic requirement in the implementation of successful screening program, which in future help in reducing the incidence of cervical cancer.

The aim of this review is to explore knowledge toward cervical cancer and knowledge, attitude and practice toward screening of cervical cancer among health professionals including medical students, physicians, dentists and nurses in India.

Methodology

Search strategy

A thorough writing search directed between 2012 and March 2020 in electronic dataset PubMed and Google Scholar was led. We retrieved all studies in English language containing information on knowledge, awareness, attitude and practice on cervical Cancer and its screening in India. Articles were included if they reported quantitative data of knowledge, awareness, attitude, or practice of cervical cancer and its screening among health professionals in India. Primary concepts of “cervical cancer,” “cervical cancer screening,” “cervical cancer knowledge,” “cervical cancer attitude,” “cervical cancer awareness,” and “cervical cancer practice” were elaborated to generate additional medical terms (cervix, cervical, cancer, neoplasm, cervical neoplasms, screening and primary diagnosis of cancer) for the search. The text word search and subject search were done in PubMed and Google Scholar individually and then combined with “OR” and “AND” operators. Combined terms were used, for example, (“CERVICAL CANCER SCREENING” or “CERVICAL SCREENING”) AND (“CERVICAL CANCER KNOWLEDGE” or “CERVICAL CANCER ATTITUDE”) or (HEALTH PROFESSIONALS). Gray literature and additional articles were identified using the bibliography of included articles and some excluded review articles.

Study selection

Articles reported quantitative data on knowledge, awareness, attitude, and practice toward screening among health professionals including medical students, community health workers (accredited social health activist (ASHA), auxilliary nurse midwife (ANM)), nurses, and practicing doctors aged between 18 and 60 years in India.

Figure 1 shows the selection process of articles retrieved. Our review was done according to PRISMA Guidelines.¹³

Figure 1.

PRISMA diagram.

Inclusion criteria

Cross-sectional studies and English language studies conducted in diverse settings like hospitals, health centers, and Medical Colleges of India published from 2012 till March 2020 on knowledge, awareness, attitude, and practice regarding cervical cancer and its screening among health professionals in India.

Exclusion criteria

Case reports, case series, earlier reviews, and qualitative studies of cervical cancer and its screening uptake were excluded. Studies conducted in low- or high-income countries other than India, articles published in languages other than English and articles conducted among women other than health professionals were excluded.

Data extraction and analysis

We extracted the following key characteristics of the studies: lead author and country, year published, study design, sample size, age group and knowledge of cervical cancer, cervical cancer signs and symptoms and risk factors, screening, attitude, and practice toward screening among health professionals. After the removal of duplicates, primary outcome data of all articles were indexed in Microsoft Excel. Later, interpretation of textual data was extracted to a Microsoft Word document. Two authors independently carried out the literature search and identified citations for knowledge, attitude, and practice on cervical cancer and screening independently. Full-text articles were identified and assessed for eligibility after applying the inclusion and exclusion criteria. Statistical software like SPSS-V.23 was used for statistical application.

Results

A total of 22 studies met the inclusion criteria that are included in the review. These studies included 6811 health professionals including medical students, community health workers (ASHA, ANM), nurses, and practicing doctors aged between 18 and 60 years. The studies included in the review are conducted across India in various tertiary care hospitals. Majority of health professionals included were married ranging from 50% to 95% (Table 1).

Table 1.

Characteristics of the studies included in the review.

Author	Study design	Year of study	Sample size	State	Population characteristics	Result
Goyal et al.¹⁴	Cross-sectional study	2012	200	Surat, Gujarat	Age: 21-50 years and above Study population—nurses of tertiary care hospital Marital status—88% married women	1. Knowledge of risk factors—multiple sexual partners: 61.5%, intercourse at early age: 44% 2. Knowledge of signs and symptoms—foul-smelling vaginal discharge: 73.5%, post-menopausal bleeding: 45.5% 3. Knowledge of Pap smear: 52.5% 4. Practice of screening: 30%
Shah et al.¹⁵	Cross-sectional study	2012	100	Gujarat	Age: 21–60 years Study population—nursing staff in tertiary care hospital Marital status—89% married women	1. Knowledge of cervical cancer: 69% 2. Knowledge of risk factors—early pregnancy: 73.9%, early marriage: 71.1% 3. Knowledge of signs and symptoms—vaginal discharge: 94.2%, menstrual abnormality: 86.55
Pandey et al.¹⁶	Cross-sectional study	2012	618	Manipal, Karnataka	Age: 17 years and above Study population—MBBS students Education level—non-clinical: 55.2%, clinical: 44.8%	1. Knowledge of cervical cancer: 89.2% 2. Knowledge of HPV vaccine: 75.6%
Singh et al.¹⁷	Cross-sectional study	2012	133	Etawah, Uttar Pradesh	Age: 21–40 years Study population—nursing staff of tertiary care hospital Marital status—61.7% married women	1. Knowledge of cervical cancer: 63.2% 2. Knowledge of risk factor—generalized: 93.1%, HPV infection: 54.1% 3. Knowledge of signs and symptoms—Foul-smelling vaginal discharge: 65.4%, bleeding per vagina: 33.4% 4. Knowledge of Pap smear: 73.7% 5. Practice toward screening: 11.3%
Shekhar et al.¹⁸	Cross-sectional study	2013	239	Rural India (State not specified)	Age: 20–50 years and above Study population—nursing staff of tertiary care hospital Marital status—86.6% married women	1. Knowledge of cervical cancer: 76.9% 2. Knowledge of risk factors—Generalized: 365 3. Knowledge of signs and symptoms—abnormal vaginal discharge: 69%, foul-smelling vaginal discharge: 65.2% 4. Knowledge of Pap smear: 80.7% 5. Practice toward screening: 15% 6. Knowledge of HPV: 25%
Thippeveeranna et al.¹⁹	Cross-sectional study	2013	224	Sikkim	Age: 20–60 years Study population—nursing staff of tertiary care hospital Marital status—92.40% married women	1. Knowledge of cervical cancer: 98.6% 2. Knowledge of risk factors—early age of marriage: 33.9%, HPV infection: 39.2% 3. Knowledge of Pap smear: 88.8% 4. Attitude toward screening: 91.5% 5. Practice toward screening: 1.6%
Kosambiya et al.²⁰	Cross-sectional study	2013	103	Surat, Gujarat	Age: 20–40 years and above Study population—nursing staff of tertiary care hospital Marital status—90.3% married women	1. Knowledge of cervical cancer: 98.1% 2. Knowledge of risk factors—non-maintenance of personal hygiene: 46.5%, HPV infection: 49.5% 3. Knowledge of signs and symptoms—intermenstrual bleeding: 65.5%, foul-smelling vaginal discharge: 57.4% 4. Knowledge of Pap smear: 94.2% 5. Practice toward screening: 3.9% 6. Knowledge of HPV vaccine: 43.7% 7. Practice toward HPV vaccine: 3.9%
Devi et al.²¹	Cross-sectional study	2014	130	Anantpur, Andhra Pradesh	Age: 21–60 years Study population—nursing staff of government medical college and hospital Marital status—7% married women	1. Knowledge of cervical cancer: 82.3% 2. Knowledge of risk factors—HPV infection: 76.1%, multiple sexual partners: 70.1% 3. Knowledge of signs and symptoms—post-coital bleeding: 77.6%, intermenstrual bleeding: 76.1%, foul-smelling vaginal discharge: 82.3% 4. Knowledge of Pap smear: 86.9% 5. Practice toward screening: 24.6% 6. Knowledge of HPV vaccine: 58.4%
Swapnajaswanth et al.²²	Cross-sectional study	2014	155	Bangalore, Karnataka	Age: 30–60 years Study population—doctors and nurses	1. Knowledge of cervical cancer: 98% 2. Attitude toward screening: 89.6% 3. Practice toward screening: 26.4%
Swarnapriya et al.²³	Cross-sectional study	2015	957	South India	Age: 18–30 years Study population—BDS, MBBS, and nursing students	1. Knowledge of cervical cancer: 60.1% 2. Knowledge of HPV vaccine: 86.4% 3. Practice toward HPV vaccine: 6.8%
Rahman and Kar²⁴	Cross-sectional study	2015	354	Sikkim	Age: 20–50 years Study population—nursing staff of tertiary care hospital Marital status—45.2% married women	1. Knowledge of cervical cancer: 90.39% 2. Knowledge of risk factors: 47.17%, intercourse at early age: 31.92% 3. Knowledge of signs and symptoms—foul-smelling vaginal discharge: 57.62%, post-menopausal bleeding: 23.44% 4. Knowledge of Pap smear: 79.1% 5. Practice toward screening: 16.5%
Vishwakarma et al.²⁵	Cross-sectional study	2016	100	Uttar Pradesh	Age: 25–40 years Study population—nursing staff of tertiary care hospital Marital status—88% married women	1. Knowledge of cervical cancer: 94% 2. Knowledge of risk factors—multiparity: 42%, multiple sexual partners: 36% 3. Knowledge of signs and symptoms—abnormal vaginal discharge: 50%, post-menopausal bleeding: 48% 4. Knowledge of Pap smear: 82% 5. Practice toward screening: 35% 6. Knowledge of HPV: 32% 7. Knowledge of HPV vaccine: 30%
Canon et al.²⁶	Cross-sectional study	2016	210	Mangalore, Karnataka	Age: 18–50 years Study population—practicing physicians	Knowledge of HPV vaccine: 47%
Chawla et al.²⁷	Cross-sectional study	2016	590	Delhi, NCR	Age: 40–50 years Study population—healthcare providers	1. Knowledge of cervical cancer: 84.06% 2. Knowledge of HPV vaccine: 81.01%
Jain et al.²⁸	Cross-sectional study	2016	157	Maharashtra	Age: 20–64 years Study population—nursing staff of tertiary care hospital Marital status: 69% married	1. Knowledge of cervical cancer: 86.2% 2. Knowledge of risk factors—non-maintenance of personal hygiene: 35.7%, early age of marriage: 32.1% 3. Knowledge of signs and symptoms—bleeding per vagina: 68.9%, foul-smelling discharge: 20.7% 4. Knowledge of screening: 86.2% 5. Attitude toward screening: 62.1%
Ganju et al.²⁹	Cross-sectional study	2017	400	Himachal Pradesh	Age: 20–60 years Study population—medical and paramedical students Marital status—12% married	1. Knowledge of cervical cancer: 34% 2. Knowledge of risk factors—HPV infection: 56.75%, intercourse at early age: 23.5% 3. Practice toward HPV vaccine: 5.5%
Anusha et al.³⁰	Cross-sectional study	2018	483	Andhra Pradesh	Age: 18–25 years Study population—medical students	1. Knowledge of cervical cancer: 72.4% 2. Knowledge of Pap smear: 87.5% 3. Knowledge of HPV: 54.8%
Choudhary et al.³¹	Cross-sectional study	2018	80	Jodhpur, Rajasthan	Age: 18–25 years Study population—medical students	1. Knowledge of HPV: 67% 2. Practice of HPV vaccine: 75%
Shetty et al.³²	Cross-sectional study	2019	988	Mangalore, Karnataka	Age: 18–26 years Study population—medical students	1. Knowledge of cervical cancer: 95% 2. Knowledge of HPV: 89.3% 3. Knowledge of HPV vaccine: 59.7%
Manikandan et al.³³	Cross-sectional study	2019	100	India (State not specified)	Age: 18–20 years Study population—medical students	1. Knowledge of cervical cancer: 30.61% 2. Knowledge of risk factors—generalized: 5.1% 3. Knowledge of Pap Smear: 2.04% 4. Knowledge of HPV vaccine: 2.04%
Khanna et al.³⁴	Cross-sectional study	2019	290	Varanasi, Uttar Pradesh	Age: 20–40 years Study population—community health workers Marital status—93.1% married women	1. Knowledge of cervical cancer: 95.5% 2. Knowledge of risk factors—multiple sexual partners: 56.55%, tobacco and smoking: 52.06% 3. Knowledge of signs and symptoms—abnormal vaginal discharge: 64.48%, post-menopausal bleeding: 63.44%, foul-smelling discharge: 77.93% 4. Knowledge of Pap smear: 44.13% 5. Attitude toward screening: 82.41% 6. Practice toward screening: 8.27%
Chauhan et al.³⁵	Cross-sectional study	2020	200	Udaipur, Rajasthan	Age: 25–40 years Study population—health care providers (ASHA workers, ANM, nurses, MBBS interns, physicians)	1. Knowledge of cervical cancer: 68.4% 2. Knowledge of risk factors—multiple sexual partners: 64%, multiparity: 23%, family history: 32% 3. Knowledge of signs and symptoms—foul-smelling vaginal discharge: 58%, bleeding per vagina: 71.5% 4. Knowledge of Pap smear: 45.5% 5. Attitude toward screening: 99% 6. Practice toward screening: 4%

HPV: human papilloma virus; ASHA: accredited social health activist; ANM: auxiliary nurse midwife.

Among 22 studies reviewed, 19 studies^{15–25,27–30,32–35} reported knowledge of cervical cancer. The overall knowledge of cervical cancer among health professionals was 75.14%. The awareness level of risk factors was adequate. Among 22 studies, 14 studies^{14,15,17–21,24,25,28,29,33–35} reported knowledge of risk factors of cervical cancer. The most common risk factor known was multiple sexual partners 44.07%, HPV infection 40.85%, and early age of marriage 38.52% (Figure 2).

Figure 2.

Knowledge of risk factors of cervical cancer among health prfessionals.

Among 22 articles reviewed, 11 articles^{14,15,17,18,20,21,24,25,28,34,35} reported knowledge of signs and symptoms of cervical cancer. The awareness level of signs and symptoms was also adequate. The most common sign and symptom reported was intermenstrual bleeding 65.48%, abnormal vaginal discharge 63.19%, foul-smelling discharge 62.90% (Figure 3).

Figure 3.

Knowledge of signs and symptoms of cervical cancer.

Based on review, the overall knowledge of screening toward cervical cancer was 86.20%. Knowledge of screening through Pap smear was 66.66%, attitude toward screening of cervical cancer was 85.47%, and practice toward screening came out to be 12.70% (Figure 4).

Figure 4.

Knowledge, attitude, and practice toward cervical cancer screening.

In the present review, the knowledge of HPV is 76.68%, knowledge of HPV vaccine, and practice toward HPV vaccine is 68.68% and 20.56%, respectively (Figure 5).

Figure 5.

Knowledge toward HPV, HPV vaccine, and practice toward HPV vaccine.

Discussion

This review focused on knowledge, attitude, and practice toward screening of cervical cancer among health professionals including medical students, community health workers (ANM, ASHA), nurses, and practicing physicians in India. The knowledge regarding cervical cancer came out to be 75.14%. Similar study conducted in Qatar showed the findings that over 80% of women had knowledge of cervical cancer.³⁶ Various studies conducted in China,³⁷ the United Kingdom,³⁸ and Hong Kong³⁹ showed that the knowledge level about cervical cancer was low among the participants, although women who were willing to participate in the screenings had a higher knowledge level.

With regard to signs and symptoms of cervical cancer, 65.48% knew about intermenstrual bleeding, 63.19% knew about abnormal vaginal discharge, 62.09% knew about foul-smelling vaginal discharge, 60.02% knew about bleeding per vagina as common symptoms of cervical cancer. A similar finding (menstrual abnormality—80.6%) was found in a study by Anya et al.⁴⁰ among female health personnel. Also, in a study conducted by Narayana et al.,⁴¹ among the 403 women who completed the survey, 64.2% had some knowledge about signs and symptoms. Despite having adequate knowledge of screening, signs and symptoms, and risk factors of cervical cancer, the practice toward screening is low, that is, only 12.70% health professionals have undergone screening test. This low uptake rate is very similar to other studies conducted among healthcare workers.^42–46 Studies among female students in Nigeria,⁴⁷ Malaysia,⁴⁸ and Turkey⁴⁸ showed low utilization of Pap test. The reason enlisted include having not thought about it and absence of symptoms, which illustrates how cervical screening is conceptualized and understood.⁴⁹

We observed positive attitude toward screening in majority of health workers, that is, 85.47% had positive attitude toward screening. Our finding was comparable to many Indian-based studies on general female population and to other community health worker–based studies in other countries.^50–54 In the present review, 44.07% health professionals told that multiple sexual partners is the risk factor; also 40.85% told HPV infection is the risk factor; 38.52% and 30.49% think that early age of marriage and early age of intercourse, respectively, are the risk factors for cervical cancer; similarly in a study by Nilaweera et al.,⁵⁴ 45% mentioned multiple partners and other promiscuous behaviors as the most common risk factors. Ali et al.⁵⁵ in their study mentioned that 81.8% and 85.6% of respondents knew that first sexual intercourse at a young age and having multiple sexual partners were risk factors for cervical cancer.

In the present review, it was seen that 76.68% health professionals had knowledge of HPV, 68.68% had knowledge of HPV vaccine but again uptake of HPV vaccine was low, that is, only 20.56% had HPV vaccine. In many European countries, almost 80% of the target population has been vaccinated; however, in developing countries, vaccination rates are disappointing.⁵⁶

Our review concluded that health professionals have optimum level of knowledge of cervical cancer and knowledge of screening toward cervical cancer, attitude toward screening is also appropriate but the uptake of screening is very low despite being a health professional. This shows that there is need for sensitization of healthcare professionals for cervical cancer screening because they play an essential role in the implementation of any future screening programs and in their educative role with patients.²²

Strength

To our knowledge, it is the first review done on the knowledge, attitude, and practice toward cervical cancer and screening among the health professionals in India. Health professionals are primary source of knowledge for people toward any disease; therefore, the review will serve as a guide for policy makers to enhance the system and create suitable awareness toward cervical cancer and screening.

Limitations

Studies included in the review vary in geographical areas in India and heterogeneity of diversified population data collected and pooled. Variations such as age range, sampling techniques, medical profession including BDS, MBBS, nurses, ANM workers were also not uniform. Merging such data may lead to high heterogeneity, which is a potential source of bias.

Conclusion

The review concludes that health professionals have optimum level of knowledge of cervical cancer and knowledge of screening of cervical cancer with appropriate attitude toward screening with low uptake of practice toward screening. There is need for implementation of practice toward screening. Despite being a health professional, there is lack of practice toward screening. There is a need for screening among health professionals because they play an essential role to educate their patients and motivate them toward screening. Health professionals play an educative role with their patients.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for the following paper is provided by ICMR (Indian Council of Medical Research) under the project entitled “Artificial Intelligence enabled early detection of Cervical Cancer in tertiary care setting and extended community.”

ORCID iD

Neha Taneja

References

Arbyn

Weiderpass

Bruni

, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health 2020; 8(2): e191–e203.

World Health Organization. Sexual and reproductive health—laying the foundation for a more just world through research and action: biennial report 2004-2005. World Health Organization, 2006, https://apps.who.int/iris/handle/10665/43497

Kaarthigeyan

Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol 2012; 33(1): 7–12.

Singh

HPV and Cervical cancer-prospects for prevention through vaccination. Indian J Med Paediatr Oncol 2005; 26(1): 20–23.

Sankaranarayanan

Budukh

Rajkumar

Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ 2001; 79(10): 954–962.

Hakama

Chamberlain

Day

, et al. Evaluation of screening programmes for gynaecological cancer. Br J Cancer 1985; 52(4): 669–673.

Arbyn

Rebolj

De Kok

, et al. The challenges of organising cervical screening programmes in the 15 old member states of the European Union. Eur J Cancer 2009; 45(15): 2671–2678.

Mishra

An epidemiological study of cervical and breast screening in India: district-level analysis. BMC Womens Health 2020; 20(1): 225.

Gedam

Rajput

DA.

Knowledge, attitudes, and practices among healthcare providers on cervical cancer, human papilloma virus and it’s vaccine at ESI PGIMSR, MGM Hospital Parel Mumbai, India. Int J Reprod Contracept Obstet Gynecol 2017; 6(9): 3855–3860.

10.

Abreu

Souza

Gimenes

, et al. A review of methods for detect human Papillomavirus infection. Virol J 2012; 9(1): 262.

11.

Canavan

Doshi

NR.

Cervical cancer. Am Fam Physician 2000; 61(5): 1369–1376.

12.

Saha

Chaudhury

Bhowmik

, et al. Awareness of cervical cancer among female students of premier colleges in Kolkata, India. Asian Pac J Cancer Prev 2010; 11(4): 1085–1090.

13.

Moher

Liberati

Tetzlaff

, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6(7): e1000097.

14.

Goyal

Vaishnav

Shrivastava

, et al. Knowledge, attitude & practices about cervical cancer and screening among nursing staff in a teaching hospital. Int J Med Sci Public Health 2013; 2: 249–253.

15.

Shah

Vyas

Singh

, et al. Awareness and knowledge of cervical cancer and its prevention among the nursing staff of a tertiary health institute in Ahmedabad, Gujarat, India. Ecancermedicalscience 2012; 6: 270.

16.

Pandey

Vanya

Bhagat

, et al. Awareness and attitude towards human papillomavirus (HPV) vaccine among medical students in a premier medical school in India. PLoS ONE 2012; 7(7): e40619.

17.

Singh

Seth

Rani

, et al. Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India. J Gynecol Oncol 2012; 23(3): 141–146.

18.

Shekhar

Sharma

Thakur

, et al. Cervical cancer screening: knowledge, attitude and practices among nursing staff in a tertiary level teaching institution of rural India. Asian Pac J Cancer Prev 2013; 14(6): 3641–3645.

19.

Thippeveeranna

Mohan

Singh

, et al. Knowledge, attitude and practice of the pap smear as a screening procedure among nurses in a tertiary hospital in north eastern India. Asian Pac J Cancer Prev 2013; 14(2): 849–852.

20.

Kosambiya

Gohil

Kamdar

, et al. Knowledge, attitude and practices about cervical cancer and screening among nurses of a tertiary care centre in Western India. Nat J Community Med 2018; 9(6): 391–395.

21.

Devi

Babu

Kumari

DA.

Nursing staff awareness of cervical cancer and pap smear screening in a remote medical college hospital in South India. Int J Res Health Sci 2014; 2: 1085–1090.

22.

Swapnajaswanth

Suman

Suryanarayana

, et al. Perception and practices on screening and vaccination for carcinoma cervix among female healthcare professional in tertiary care hospitals in Bangalore, India. Asian Pac J Cancer Prev 2014; 15(15): 6095–6098.

23.

Swarnapriya

Kavitha

Reddy

GM.

Knowledge, attitude and practices regarding HPV vaccination among medical and para medical in students, India a cross sectional study. Asian Pac J Cancer Prev 2016; 16(18): 8473–8477.

24.

Rahman

Kar

Knowledge, attitudes and practice toward cervical cancer screening among Sikkimese nursing staff in India. Indian J Med Paediatr Oncol 2015; 36(2): 105–110.

25.

Vishwakarma

Rawat

Mittal

, et al. Knowledge, attitude and practices about cervical cancer screening among nursing staff in rural tertiary care center. Int J Reprod Contracept Obstet Gynecol 2018; 7(9): 3796–3800.

26.

Canon

Effoe

Shetty

, et al. Knowledge and attitudes towards human papillomavirus (HPV) among academic and community physicians in Mangalore, India. J Cancer Educ 2017; 32(2): 382–391.

27.

Chawla

Chaudhary

Knowledge, attitude & practice on human papillomavirus vaccination: a cross-sectional study among healthcare providers. Indian J Med Res 2016; 144(5): 741–749.

28.

Jain

Bagde

ND.

Awareness of cervical cancer and Pap smear among nursing staff at a rural tertiary care hospital in Central India. Indian J Cancer 2016; 53(1): 63–66.

29.

Ganju

Gautam

Barwal

, et al. Assessment of knowledge and attitude of medical and nursing students towards screening for cervical carcinoma and HPV vaccination in a tertiary care teaching hospital. Int J Community Med Public Health 2017; 4(11): 4186–4193.

30.

Anusha

Jyotsna

Naidu

LV.

Medical students perspective about cervical cancer, screening and HPV vaccination in a tertiary care teaching hospital in rural Vizianagaram, Andhra Pradesh. J Med Sci Clin Res 2018; 6, http://jmscr.igmpublication.org/home/index.php/archive/155-volume-06-issue-10-october-2018/5845-medical-students-perspective-about-cervical-cancer-screening-and-hpv-vaccination-in-a-tertiary-care-teaching-hospital-in-rural-vizianagaram-andhra-pradesh

31.

Choudhary

Jodha

BSSCPP

Yadav

, et al. Knowledge of HPV and attitude towards HPV vaccination among medical students of Jodhpur, Rajasthan. Int J Med Health Res 2018; 4(3): 94–97.

32.

Shetty

Prabhu

Shetty

, et al. Knowledge, attitudes and factors associated with acceptability of human papillomavirus vaccination among undergraduate medical, dental and nursing students in South India. Hum Vaccin Immunother 2019; 15(7–8): 1656–1665.

33.

Manikandan

Behera

Naidu

, et al. Knowledge and awareness toward cervical cancer screening and prevention among the professional college female students. J Pharm Bioallied Sci 2019; 11(Suppl. 2): S314–S320.

34.

Khanna

Khargekar

Budukh

Knowledge, attitude, and practice about cervical cancer and its screening among community healthcare workers of Varanasi district, Uttar Pradesh, India. J Family Med Prim Care 2019; 8(5): 1715–1719.

35.

Chauhan

Gupta

Gandhi

Study of knowledge, attitude, and practice regarding cervical cancer and its screening among health service providers of Udaipur. Int J Clin Obstet 2020; 4: 167–170.

36.

Al-Meer

Aseel

Al-Khalaf

, et al. Knowledge, attitude and practices regarding cervical cancer and screening among women visiting primary health care in Qatar. East Mediterr Health J 2011; 17(11): 855–861.

37.

Chan

Twinn

How sexual history and knowledge of cervical cancer and screening influence Chinese women’s screening behavior in mainland China. Cancer Nurs 2010; 33(6): 445–453.

38.

Fylan

Screening for cervical cancer: a review of women’s attitudes, knowledge, and behaviour. Br J Gen Pract 1998; 48(433): 1509–1514.

39.

Twinn

Holroyd

Adab

The influence of intrinsic and extrinsic factors on uptake rates for cervical screening: a comparison of Hong Kong Chinese women and practitioners. Hong Kong Med J 2006; 12(Suppl. 2): S19–S21.

40.

Anya

Oshi

Nwosu

, et al. Knowledge, attitude, and practice of female health professionals regarding cervical cancer and Pap smear. Niger J Med 2005; 14(3): 283–286.

41.

Narayana

Suchitra

Sunanda

, et al. 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): 481–487.

42.

Mutyaba

Mmiro

Weiderpass

Knowledge, attitudes and practices on cervical cancer screening among the medical workers of Mulago Hospital, Uganda. BMC Med Educ 2006; 6(1): 13.

43.

Udigwe

GO.

Knowledge, attitude and practice of cervical cancer screening (pap smear) among female nurses in Nnewi, South Eastern Nigeria. Niger J Clin Pract 2006; 9(1): 40–43.

44.

Arulogun

Maxwell

OO.

Perception and utilization of cervical cancer screening services among female nurses in University College Hospital, Ibadan, Nigeria. Pan Afr Med J 2012; 11: 69.

45.

Awodele

Adeyomoye

Awodele

, et al. A study on cervical cancer screening amongst nurses in Lagos University Teaching Hospital, Lagos, Nigeria. J Cancer Educ 2011; 26(3): 497–504.

46.

Gharoro

Ikeanyi

EN.

An appraisal of the level of awareness and utilization of the Pap smear as a cervical cancer screening test among female health workers in a tertiary health institution. Int J Gynecol Cancer 2006; 16(3): 1063–1068.

47.

Al-Naggar

Low

Isa

ZM.

Knowledge and barriers towards cervical cancer screening among young women in Malaysia. Asian Pac J Cancer Prev 2010; 11(4): 867–873.

48.

Aniebue

UU.

Awareness and practice of cervical cancer screening among female undergraduate students in a Nigerian university. J Cancer Educ 2010; 25(1): 106–108.

49.

Anantharaman

Sudharshini

Chitra

A cross-sectional study on knowledge, attitude, and practice on cervical cancer and screening among female health care providers of Chennai corporation, 2013. J Acad Med Sci 2012; 2(4): 124–128.

50.

Siddharthar

Rajkumar

Deivasigamani

Knowledge, awareness and prevention of cervical cancer among women attending a tertiary care hospital in Puducherry, India. J Clin Diagn Res 2014; 8(6): OC01–13.

51.

Zutshi

Dankher

Malik

Cervical cancer screening and prevention: an analysis of beliefs and predictors of knowledge, attitude and practice in Northern India. Indian J Gynecol Oncolog 2017; 15(4): 71.

52.

Zahedi

Sizemore

Malcolm

, et al. Knowledge, attitudes and practices regarding cervical cancer and screening among Haitian health care workers. Int J Environ Res Public Health 2014; 11(11): 11541–11552.

53.

Dulla

Daka

Wakgari

Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study. Int J Womens Health 2017; 9: 365–372.

54.

Nilaweera

Perera

Paranagama

, et al. Knowledge and practices on breast and cervical cancer screening methods among female health care workers: a Sri Lankan experience. Asian Pac J Cancer Prev 2012; 13(4): 1193–1196.

55.

Ali

Ayub

Manzoor

, et al. Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in Tertiary Care Hospitals in Karachi, Pakistan. PLoS ONE 2010; 5(6): e11059.

56.

Cetinkaya

Apaydin

, et al. Awareness and knowledge levels of Turkish college students about human papilloma virus infection and vaccine acceptance. J Cancer Educ 2018; 33(2): 260–268.

Knowledge,attitude,and practice on screening toward cervical cancer among health professionals in India—A review

Abstract

Background:

Objective:

Materials and methods:

Results:

Conclusion:

Keywords

Introduction

Methodology

Search strategy

Study selection

Inclusion criteria

Exclusion criteria

Data extraction and analysis

Results

Discussion

Strength

Limitations

Conclusion

Footnotes

Declaration of conflicting interests

Funding

ORCID iD

References