A scoping review to determine levels of knowledge, attitudes and screening practices towards breast and cervical cancer among women in Nepal


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Candice Rademaker1, Helena Harder1
1Brighton and Sussex Medical School

Abstract

Background

Cancer is a leading cause of morbidity and mortality worldwide. The global burden of cancer is increasingly seen in low-income and middle-income countries (LMICs), such as Nepal. This is the first review on knowledge, attitudes and screening practices for breast cancer (BC) and cervical cancer (CC) among women in Nepal with an aim to inform cancer education programmes.

Method

A scoping review was conducted according to the framework proposed by the Joanna Briggs Institute. Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed) and grey literature sources were searched for articles published in English from inception to January 2021. Reference and citation lists were hand searched for additional publications. Search results were screened against inclusion/exclusion criteria. Two independent reviewers extracted data from eligible studies. Results were summarised narratively.

Results

Thirty-nine articles from 615 screened were included. Twenty-eight studies focused on CC, 10 on BC and one included both cancers. Most (90%) had a quantitative research design using a researcher/clinician administered survey. Mean age of women ranged from 17 to 53 years. Levels of knowledge of CC and BC varied widely. Knowledge gaps included misconceptions about risk factors and symptoms, and poor understanding of screening behaviours. Positive attitudes towards CC screening were associated with higher levels of education and increased knowledge of screening modalities. Attitudes towards the human papillomavirus vaccine were positive. Screening practice of most women was inadequate; most common barriers were socio-cultural, geographical or financial. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated screening.

Conclusion

Knowledge and screening practices for BC and CC among Nepalese women were poor. These findings align with research from other LMICs and warrant the need for education programmes. Future interventions for CC, helping to meet the WHO target of the global elimination of CC by the end of the century, could involve community health worker-led awareness and screening initiatives. Programmes to increase practice of breast self-examination, and the introduction of clinical breast examination in Nepal could support early diagnosis of BC.

Impact statement

Future research into culturally sensitive cancer education programmes is needed to improve cancer outcomes and reduce inequality for women in Nepal.