Knowledge, attitudes and practices (KAP) of screening for cervical cancer in India: A systematic review

Background: Cervical cancer is the 2nd most frequent cancer in women in India and accounts for a quarter of all cervical cancer deaths worldwide. Yet, estimated coverage of cervical cancer screening is ~3.8% in India. 

Objectives: We assessed knowledge of cervical cancer, awareness and practice of cervical cancer screening methods for early detection among women across rural and urban India.

Methods: A systematic review of peer-reviewed studies on knowledge, attitudes and practices of cervical cancer screening of women in India was conducted with searches on three major databases (PubMed, Embase and Cochrane Library). Two authors independently screened 214 articles based on a pre-determined inclusion criteria and 11 articles were identified. The study quality was evaluated using a checklist for cross-sectional surveys adapted from Pettigrew and Roberts. 

Results: Of the 11 identified studies, 6 had women who visited OPDs, 4 had nurses and 1 had doctors and nurses as survey participants. 9 studies evaluated knowledge about symptoms and risk factors for cervical cancer. All studies evaluated understanding of the Papanicolaou (Pap) smear test. Utilization of the test was shown to be dependent on socio-demographic characteristics.

Conclusions: Major concerns include poor knowledge of even antiquated techniques like Pap test and unwillingness to undergo screening. Healthcare professionals need to be at the forefront of a new program that enables greater awareness and utilization of screening amongst women. A developing country like India demands a nation-wide cervical cancer screening program to tackle a major burden on women’s health.