Introduction

A carcinoma of the cervix is a malignant tumour arising from the cells of the cervix. According to Globocan 2020, there were 604,100 newly diagnosed cases of cervical cancer worldwide, resulting in 341,831 fatalities.1 In India, there are 436.76 million women aged 15 and older who face the risk of developing cervical cancer. Remarkably, cervical cancer stands as the second most prevalent cancer among women in the reproductive age bracket.2 Cervical cancer (CC) is attributed to the human papillomavirus (HPV), with HPV-16 and HPV-18 being the primary culprits, accounting for 70%–80% of total cases. Indian studies indicate that approximately 82.7% of invasive cervical cancers exhibit the presence of either HPV-16 or HPV-18.3 Several common risk factors associated with carcinoma cervix include poor personal hygiene, low socioeconomic status, Human papillomavirus infection, multiple sexual partners, multiple child births, early marriage, and sexual practice, early childbirth (before the age of 20), HIV infection, use of oral contraceptives & smoking, etc.3

Cervical cancer, out of all female genital tract cancers, can be prevented if detected at its early stages. Organized cervical screening programs have reduced incidence & mortality from cervical cancer by 80% in developed countries.4 Effective primary (HPV vaccine) and secondary (cervical cancer screening and treating precancerous lesions) preventive measures will reduce the cases of cervical cancer. PAP smear screening is an effective tool for screening cervical cancer but most of the women in developing and underdeveloped countries do not have access to it. The major hurdle is their lack of participation in screening programs.5 In India cervical cancer screening is only 1.9% ranging from 0.2% in Gujrat to 9.8% in Tamil Nadu.6 Even more than a decade after the introduction of the HPV vaccine, the prevalence of cervical cancer is quite alarming in India, universal cervical screening is an unmet need.6

Awareness regarding cervical cancer and its prevention is quite low in Indian women. It is necessary to make medical staff aware of cervical cancer so that they can impart knowledge regarding cervical cancer and its prevention to the general public.7 The reported hurdle to screening cervical cancer includes a lack of awareness, knowledge of symptoms & risk factors, stigma and misconception about gynaecological diseases which results in underutilization of preventive measures. Healthcare staff with proper knowledge play a huge role in influencing the beliefs and practices of the general public, therefore their knowledge needs to be assessed and updated regularly.

The present study explores the basic knowledge of cervical cancer, its risk factors and preventive measures among female healthcare professionals and medical students.

Materials and Methods

A cross-sectional study among all female healthcare providers comprising doctors, medical students (1st, 2nd & 3rd-year MBBS), and nurses was conducted at Gautam Buddha Chikitsa Mahavidyalaya, Jhajhra, Dehradun, in December 2023. All participants who gave consent to participate in this study were included which comprised a total of 205 in number.

Google form platform was used to conduct the pre-composed online survey, and an informed consent was taken from all individuals on the first introductory page of the survey. The questionnaire was devised based on existing research findings following a thorough study of the literature. 10-13 The survey did not include the names and IDs of participants to maintain confidentiality.

The questionnaire was divided into three sections. Section A- questions regarding the demographic characteristics of the participants. Section B- questions about various risk factors of cervical carcinoma such as early sexual intercourse, multiple sexual partners, HPV infection and other factors, and Section C - questions about cervical carcinoma being the leading cause of death among all cancers in India among females, cervical cancer being preventable, etc. were asked for assessment of knowledge of the participants regarding cervical cancer and its preventive measures. For Sections B and C, for each question, there were two options YES or AGREE and NO or DISAGREE. The scale was subsequently dichotomized assigning a value of 1 to “YES” and 0 to “NO”.

Results

A total of 205 female participants contributed to the study which included 35 doctors, 54 nurses, and 116 medical students (1st, 2nd, and 3rd year MBBS).

Table 1 describes the demographic characteristics of participants. The majority of study subjects (67.32%) belong to the 20-30 year age group. 78.54% of respondents were unmarried and 56.59% of participants had a senior secondary certificate as the maximum level of education at the time of conduction of study.

A maximum number (141) of participants identified HPV infection as a risk factor for cervical cancer followed by multiple sexual partners (137) while 41.95% of subjects knew about early pregnancy as a risk factor for Cervical cancer. For all variables, knowledge of risk factors is highest among doctors followed by nurses and students (Table 2).

Table 3 provides knowledge of cervical Cancer prevention among participants. 81.95% of participants had knowledge that cervical cancer is preventable and screening helps in the prevention of cervical cancer. Knowledge of cervical Cancer prevention among doctors is highest for all variables related to cervical cancer prevention.

Discussion

Cervical cancer is one of the preventable gynaecological cancers. The prime purpose is early detection during the pre-invasive phase and treatment. Screening with pap smear is an effective method of cervical cancer screening and HPV vaccination provides primary prevention against carcinoma cervix.8

The knowledge, perception, and beliefs of healthcare providers are very important as they play a key role in the propagation of information to the general population. This study was conducted to evaluate knowledge, awareness, and orientation toward cervical cancer and its preventive measures among healthcare providers and medical students.

In this study, the majority (81.48%) of nursing employees were 21 to 30 years of age, younger than those in previous studies7, 9 and unmarried (62.96%) in comparison to other studies.7, 9 where a greater number were married.

100% of doctors accepted HPV infection as a cause of cervical cancer and agreed that cervical cancer is preventable with pap smear screening test and HPV vaccination. Multiple sexual partners and HIV infection (85.71%) were both recorded as the second most common risk factor while early pregnancy and multiple births recorded the least associated risk factor among doctors.

Chawla et al10 recorded fairly high cervical cancer knowledge (84.06%) among healthcare providers but only 81.01% were aware of the HPV vaccine. A study conducted by Swapnajaswanth et al11 also found 78.9% of doctors had very good knowledge of cervical cancer whereas Heena et al12 found only 11% of doctors had fair knowledge while only 3% had good knowledge of cervical cancer.

The level of knowledge possessed by nursing staff is adequate though relatively less than doctors. 87.03% of participants admitted that HPV infection is a cause of cervical cancer. Awareness about HPV infection has been improved as compared to previous studies where 54.1%,13 25%14, 39.2%,15 and 49.5%16 of nursing staff admitted HPV infection as a cause of cervical cancer.

In the present study, HPV infection was documented as the most common risk factor for cervical cancer. These findings are consistent with studies done by Devi et al17 and Thipeveeranna et al15 whereas in various previous studies, early pregnancy,7 multiparity,18 non-maintenance of personal hygiene,19 multiple sexual partners9 were recorded as the most common risk factor.

Prevention with HPV vaccination has been acknowledged by 79.62% of nursing employees which is higher in contrast with earlier studies where only 30%,18 43.7%,16 and 58.4%17 of nursing staff were aware of HPV vaccination.

Pap smear test for cervical carcinoma screening was known to 81.48% of nurses which is nearly similar to what was found in previous studies.14, 15, 16, 17

In this study, HIV infection and multiple sexual partners (56.03%) were identified as the most common risk factors by medical students whereas multiple births were believed to be the least common role to play. Half (50.86%) of students accepted HPV infection as a risk factor for cervical cancer which is almost the same as found in previous studies by Ganju et al20 (56.75%), Anusha et al21 (54.8%) but quite low as compared to studies done by Chaudhery et al22 and Shetty et al.23

45.68% of medical undergraduates were aware of cervical cancer prevention with HPV vaccination, which is considerably low as opposed to studies conducted by Chaudhery et al22 (75%) and Pandey et al24 (75.6%) and nearly the same as the study by Shetty et al23 (59.7%).

Even though 70.68% of students agreed that cervical cancer is preventable and screening helps in its prevention, only 49.13% had knowledge of pap smear test. This is similar to the study conducted by Anusha et al21 (52.5%) while Singh et al2 recorded 78.78% of medical students (1st, 2nd, and 3rd-year MBBS) aware of the pap smear test.

Former studies conducted on medical students discovered different levels of knowledge in medical undergraduates according to their level of education. Students of MBBS final year had more knowledge than 3rd year and so forth.

In the present study 1st, 2nd, and 3rd year MBBS students were included and their knowledge rightly reflected their level of medical education since cervical cancer had not been introduced in their academic curriculum. Pandey et al25 and Wanderley et al24 associated seniority of the semester with the increasing trend of knowledge in medical students.

The present study has limitations of having all participants from one institute therefore these results cannot be generalized.

Conclusion

In this extensive research endeavour, healthcare providers, particularly doctors, showcased an impressive depth of knowledge regarding cervical cancer's risk factors and preventive measures. Their expertise spanned various dimensions of this critical health issue. On the other hand, nursing personnel demonstrated proficiency in areas such as pap smears, HPV infection, and vaccination, yet their understanding seemed somewhat constrained when it came to recognizing additional prevalent risk factors within the specific context of Indian society. This highlights the significance of addressing these gaps to foster a more comprehensive awareness.

Moreover, a noteworthy finding emerged from the study: medical undergraduates revealed a notable gap in their understanding of cervical cancer risk factors and prevention methods. This revelation underscores the urgency for targeted educational interventions to enhance the awareness and preparedness of the next generation of healthcare professionals in effectively combating cervical cancer. Moving forward, closing these knowledge gaps among both healthcare providers and students becomes imperative for a more robust and well-informed approach to cervical cancer prevention and management.

The study's focus on female healthcare workers as participants stems from the societal preference of female patients feeling more at ease with women in healthcare roles. This comfort level fosters opens communication. Hence, the research emphasises the need to raise awareness, particularly among these female healthcare workers, who can play a crucial role in further disseminating information and awareness on this important health issue.

Recommendation

Given the absence of a nationwide program for pap smear screening or HPV vaccination in India, the influence of knowledgeable and well-trained healthcare professionals becomes paramount in shaping societal perceptions and behaviours towards preventing such avoidable diseases. Continuous knowledge enhancement for nursing personnel is particularly vital, considering that women frequently seek advice from them. Simultaneously, a strategic integration of HPV and cervical cancer topics into the medical curriculum is imperative from the early stages. Medical undergraduates, being conduits of information in today's era of social media, can play a pivotal role in disseminating awareness within the community.

Source of Funding

None.

Conflict of Interest

None.