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Indian Journal of Community Medicine

A Community Based Study on the Prevalence of Risk Factors of Cancer Cervix in Married Women of a Rural Area of West Bengal

Author(s): Aparajita Dasgupta, Narendra N. Naskar*, Rama Ram**, Sila Deb

Vol. 27, No. 1 (2002-01 - 2002-03)

Deptt. of P.S.M., AIIH & PH, Kolkata Deptts. of P.S.M. & *Occupational Health, AIIH & PH, Kolkata *Deptt. of P.S.M., Calcutta National Medical College, Kolkata

Abstract :

Research question: What is the prevalence of the established risk factors associated with cancer cervix?

Objective: To assess the presence of some determinants of cancer cervix among married, rural women of reproductive age group.

Study design: Community based, cross-sectional, observational study.

Setting: Rural, Village East Gobindopur in Singur block in Hooghly district of West Bengal.

Study population: All the married women of reproductive age group (103) of the village were included in the study.

Results: More than two-third (72.8%) of the study population belonged to the vulnerable age group (25-45 years) for this disease while 59.3% were married before they attained 18 years of age. Again 50% (approx.) of the married women gave birth to their first child before they were 18 years of age. One-third of the study population had parity higher than three. Two-third of the women studied were using one or more methods of family planning and one-third of the same population were permanently sterilized, 20% were using oral contraceptive pills and only 7.7% were using barrier methods of contraception. Only 31% of the women had satisfactory genital hygiene practice and 36.9% had symptoms of reproductive tract infection.

Conclusion: There was a high prevalence of some important risk factors associated with cancer cervix like age, age of marriage, age of first child birth, parity, family planning practices, genital hygiene and reproductive tract infections in the study population. Therefore, screening and early detection efforts can be directed specifically to the group at risk.

Keywords :Cancer cervix, Risk factors, Rural women

Introduction:

The traditional image of cancer is one of fear and pain. Over the years, this image has improved and many cancers are curable, provided they are detected early and treated effectively. Therefore, to control the disease, clear understanding of factors contributing to development of cancer is necessary. In this situation, the level of awareness of the population regarding the risk factors, symptoms of the disease and the importance of early treatment are important for control and even prevention of the disease and so the present study on the prevalence of risk factors of cancer cervix among married women of a village in West Bengal was conducted.

Material and Methods:

It is a community based, cross-sectional type observational study conducted in East Gobindopur village, Singur Block in Hooghly district of West Bengal. It was undertaken from October 2000 to January 2001. 103 married women of reproductive age group were included in the study. Data was collected by direct interview method.

Results:

Table I: Distribution of the respondents according to age.

Age in years No. %
15-19 1 (0.97)
20-24 27 (26.21)
25-29 25 (24.27)
30-34 34 (33.00)
35-39 13 (12.62)
40-44 3 (2.91)
Total 103 (100)

More than two third (72.8%) of the study population belonged to the vulnerable age group (25 to 45 years) for this disease. Out of 103 married women, 36(34.95%) were illiterate or just literate.

Table II: Distribution of the respondents according to age of marriage.

Age of marriage in years No. (%)
15 21 (20.3)
15-48 40 (38.9)
19-22 38 (2.9)
23-26 3 (2.9)
27-30 1 (0.9)
Total 103 (100)

61(59.3%) women were married before they attained the age of 18 years i.e. before the legal age of marriage.

Table III: Distribution of the respondents according to age of first child birth (n=95)*.

Age of first child birth in years No. (%)
15-18 47 (49.5)
19-22 37 (38.9)
23-26 10 (10.6)
27-30 1 (1.0)
Total 103 (100)

*8 women were childless.

Table III shows that 95 of the married women in this study group had children of which 47(49.5%) women gave birth of their first child before they were 18 years old.

Table IV: Distribution of the respondents according to the number of children.

No. of children No. (%)
0 8 (7.8)
  27 (26.2)
2 34 (33.0)
3 34 (33.0)
Total 103 (100)

About one third of the women (33%) were with parity higher than three as shown in Table IV.

Table V: Distribution of the respondents according to practice of genital hygiene and literacy level.

Genital hygiene Illiterate Primary Secondary Graduate Total
Satisfactory use of soap and water 9 (25) 11 (28.2) 10 (38.5) 2 (100) 32 (31.1)
Unsatisfactory use of soap and water 27 (75) 28 (71.8) 16 (61.5) 0 0 71 (68.9)
Total 36 (100) 39 (100) 26 (100) 2 (100) 103 (100)

Figures in parentheses are percentages.

According to Table V, 32(31%) of the women had satisfactory practice of genital hygiene compared to 71(69%) of them with unsatisfactory genital hygiene. It was also seen that satisfactory genital hygiene practices definitely increased with increasing levels of education.

Table VI: Distribution of the respondents according to symptoms of reproductive tract infection and literacy level.

Leucorrhoea/purulent vaginal discharge Illiterate Primary Secondary Graduate Total
Present 20 (55.6) 11 (28.2) 7 (26.9) 0   38 (36.9)
Absent 16 (44.4) 28 (71.8) 19 (73.1) 2 (100) 65 (63.1)
Total 36   39   26   2   103  

Figures in parentheses are percentages.

38(36.89%) women had symptoms of reproductive tract infection like leucorrhoea and muco-purulent discharge. There was significant increase in symptoms of reproductive tract infection (p<0.05) with decrease in literacy level.

It was also observed that 44(42.71%) of the women had no idea about the risk factors responsible for cancer cervix. Two third of these women were using one or more method of family planning and one third of them were permanently sterilised. 21(20.38%) of the women were using pills as contraceptives and 8(7.7%) were using barrier method of contraception.

Discussion:

Several studies 2-7 reveal that there is definite association of some risk factors like early marriage, high parity, unsatisfactory genital hygiene, reproductive tact infections etc. with cancer cervix. The factor of early marriage is predominant in the present study since 61(59.3%) of the population consummated marriage before they attained the age of 18. Dutta et al 2 in their study found that estimated relative risk for developing cancer cervix among women getting married before 17 years of age was found to be 7.9 as compared to women who were married after the age of 17 years. Mohanty et al 3 in their study observed that there was decline of cancer cervix as the age of 1st marriage/1st pregnancy advanced to 20-24 years. Similarly, a significant association was found between early marriage and cancer cervix by several authors 4-6 . Early age at marriage indicates an early exposure to sexual activities and early pregnancy which are well known etiological factors for cancer cervix. These factors result in longer duration of married life, with greater opportunities for sexual activities and increased chances of becoming pregnant, all this being associated with the disease.

47(49.5%) of the 95 women who had children, gave birth to their first child before they were 18 years old. Mohanty et al 3 in their study found that the mean age of first pregnancy was as low as 18.13 years. There was a decline in the cancer occurrence as the age at first pregnancy advanced to 20-24 years. Similarly, Dutta et al 2 observed in their study the relative risk of acquiring the disease was 6 times more in case of women who had first parity before 18 years of age (p<0.0001) as compared to those who had the fist parity after the age of 18 years. Lower age at first parity was found to be significantly associated with subsequent development of cancer cervix. This may be attributed to early sexual activities, hormonal changes during pregnancy or may be due to cervical trauma during delivery at a relatively younger age of mother. Wahi et al 6 in an ICMR collaborative study, also reported highest rate of cancer cervix where age at first pregnancy was upto 19 years.

In the present study, one third of the study population had more than three children. Dutta et al 2 found out that there is a significant association between increased parity and occurrence of cervical neoplasia (p<0.05) and the relative risk was found to be 2. Again Mohanty et al 3 in their study observed that 93% of all cervical cancer patients had more than 3 children. Similarly, Nawalkha et al 7 noticed significant association between parity three and above and occurrence of cancer cervix. Thus multi-parity is a well known risk factor for cancer cervix 8 focussing just not on the frequency of coitus but also on the assault on the cervix during child birth.

In the present study, 71(69%) women had poor standard of genital hygiene. In a study by Dutta et al2, 26.1% of the women with cervical cancer had poor standard of genital hygiene and the estimated relative risk was 2.5. Significant association between poor genital hygiene and cancer cervix was also evident in Roy Chowdhury's study 6 . However, authors came across one Indian study where it was suggested that woman's personal hygiene had a minimal role to play in the development of the disease.

Two-third of the study population used one or more methods of contraceptives while only 8(7.7%) were using barrier methods of contraception. Boyd and Doll 8 demonstrated a slightly reduced incidence of cancer cervix in those using barrier contraceptives and higher incidence in those using oral contraceptive pills. Similarly, Mohanty et al 3 observed that 10% of the population was using oral contraceptives pills.

In conclusion it may be mentioned that various established risk factors of cancer cervix like early marriage, increased and early parity, low literacy, poor genital hygiene and symptoms of reproductive tract infection are highly prevalent in the study population. Hence health administrators should plan and organise suitable programmes to impart health education to these vulnerable groups for improving their awareness regarding cancer cervix.

References:

  1. WHO (1999): Health situation in the South East Asia Region 1994-1997. Regional Office for SEAR, New Delhi.2.
  2. Dutta PK et al: A case-control study of cancer cervix patients attending command hospital, Pune. Indian Journal of Cancer, June 1990; 27: 101-6.
  3. Mohanty Jita, Mohanty Badal K. Risk factors in invasive carcinoma of cervix J. Obst. & Gynae., India Jan 1991: 403-6.
  4. Saraiya UB et al. Socio-economic profiles of women with cancer cervix. Dysplasia and a control group. J Obst. & Gynae. India. 1978; 18-23.
  5. Wahi et al. Religion and cervical carcinoma in Agra. Indian Journal of Cancer. 1972(9): 210-15.
  6. Roy Chowdhury NN. Epidemiological trends in incidence of cancer of the cervix. J Obst. & Gynae., India 1978(28); 1025-9.
  7. Nawalkha PC et al. Carcinoma of uterine cervix: (A clinical study of 1692 cases). J Obst & Gynae, India 1977(27): 794-753.
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