After cardiovascular disease, cancer is the second most common cause of death in India. A new diagnosis of severe cervical cancer is given to around 500,000 women annually, the majority of whom have never had screening. The developing world bears most of the load, about 85% of it. Cervical cancer has the greatest age-standardized incidence of any malignancy in South Asia and is the most common cancer-related death in India, accounting for roughly 10% of all cancer-related deaths. Therefore, more health education is needed in India to increase public awareness of the effects of cervical cancer on health [1-3].

Although there are screening programmes for cervical cancer in India, very few women are aware of them. Those who are aware of it may have a different perspective or attitude towards cervical cancer screening. In undeveloped countries like ours, more than three-fourths of cervical cancer patients obtain their diagnosis at an advanced stage, which negatively affects their prospects of long-term survival and cure [2,4].

The fact that boosting the uptake of cervical cancer screening programmes continues to be a serious public health issue contributes to the high prevalence of cervical cancer in developing countries. Despite the fact that most governments in developing countries encourage increased uptake by offering free services to women, the majority of women do not embrace cervical cancer screening [3,5].

Studies have found that a number of urban legends are responsible for the low uptake of cervical screening exercises. Women frequently think that getting screening tests may result in bad health problems like infections, infertility, abortions, sexual violence, unstable marriages, and even death. Researchers claim that educating women on the importance of cervical screening and ways to prevent  cervical cancer will increase  their  knowledge  of the condition's prevalence. Researchers have also stressed that a lack of awareness of the importance of cervical screening tests is the main cause of the underutilization of services for cervical cancer screening [4-7].

Cervical cancer screening studies have been carried out in large numbers across India, however very few have been carried out in the state of Himachal Pradesh. The purpose of this study was to ascertain the level of awareness about cervical cancer screening among women in the state.

Objectives of the Study

To evaluate the awareness about cervical cancer screening among women attending outpatient department of Civil hospital Sunni in Shimla, Himachal Pradesh.

Research Methodology

• Research Approach -Descriptive

• Research Design-Hospital based cross-sectional survey design

• Setting of the study-OPD in Civil hospital Sunni in Shimla, Himachal Pradesh.

• Study duration-between January 2023- March 2023

• Study population- women age between 18-60 years came to OPD 

• Sample size- 400 women, assuming 50% have adequate knowledge regarding cervical cancer screening, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling Technique- convenience Sampling technique

• Sampling criteria- first five women who came to OPD were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent was taken from them and confidentiality of the selected participants was also maintained 

• Inclusive Criteria- Women who were willing to participate in the study.

• Exclusion Criteria: women who were not willing to participate in the study

• Description of Tool- 

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income etc..

• Questionnaire: The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know). The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection by under the guidance of supervisors and participants were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage.

The goal of the current study was to assess the awareness about cervical cancer screening among women attending outpatient department of Civil hospital Sunni in Shimla, Himachal Pradesh.

Table 1: Socio demographic characteristics of the participants

A total of 400 respondents including 145 (36.25%) were from urban area and 255(63.75%) were from rural area were participated in the study. 

Among the total of 400 women came to OPD, maximum 118(29.5%) were having age between 21-30 years, educated up to Matric & Senior Secondary 166(41.5%) Hindu 376(94.0%) and unemployed (Housewife/others) 301(75.25%).

Table 2:      Knowledge regarding cervical cancer screening among study participants

In the present study 15.5%(62) participants had very good knowledge (16-20 marks) towards cervical cancer screening , 26.25% (105) had good knowledge (12-15 marks), 34.5%(138) had fair knowledge (8-11 marks) and 23.75% (95) having poor knowledge (<8 marks).

Table 3: Knowledge score regarding cervical cancer screening among study participants

Maximum =20 Minimum=6

The majority of cervical cancer occurrences are preventable. The fact that HPV contributed to the development of cervical cancer makes the adoption of cervical cancer prevention conceivable. The main technique of cervical cancer prevention is HPV vaccination, which aims to shield women from the oncogenic HPV strains that are the main cause of the disease. By doing a cervical screening, abnormalities can be identified and treated while still in the precancerous stage, halting the development of those abnormalities into cervical cancer. This is possible because cervical cancer is one of the few types of cancer that has a precancerous stage that lasts for a long period before the development of an invasive disease, making detection and treatment possible [3,8,9].

The findings of this study have provided data on women's knowledge about cervical cancer screening in the study area, which may be utilised to create efficient interventions and serve as the basis for further, extensive research in other parts of the country. Our findings indicate that women in Himachal Pradesh who participated in the study and were of childbearing age had insufficient knowledge of cervical cancer screening. The benefits of cervical cancer screening tests should therefore be made known to women, so appropriate and considerable action should be performed in this regard [4,5,10].

By repeating the screening test at predefined rescreening intervals, cervical screening can more effectively detect precancerous anomalies than the drawn-out preinvasive stage of squamous cervical cancers. Recognising cervical screening as a regular plan of rescreening rather than a single opportunistic test was essential. Precancerous abnormalities were found through cervical screening using the Papanicolaou smear, or "PAP test," with cells taken from the transformation zone of the cervix, the region of the cervix where the glandular cells from the endocervical canal and squamous cells from the outer opening of the cervix meet (where most cervical abnormalities and cancers are detected) [6,7,11].

Reducing the prevalence of cervical cancer will advance efforts to achieve Sustainable Development Goals 3 and 5, which call for gender equality and excellent health and wellbeing, respectively, by increasing the average woman's life expectancy. Consequently, the government should encourage greater uptake of cervical cancer screening by making the services accessible and affordable. The government should actively promote cervical cancer screening while also supporting successful community mobilization [3,6,12].

Limitations of the study 

Due to the limited sample size and cross-sectional character of the current investigation, it was challenging to generalize the results. Future studies should concentrate on qualitative investigations with a larger sample size, including focus group interviews, to identify obstacles to promoting proper knowledge about cervical cancer screening.

These results imply that the majority of the study participants' women were not aware of cervical cancer screening. Cervical cancer develops gradually, is treatable, and may be avoided with screening, so it is devastating when women die from cervical cancer. Information gaps must be filled before the women reach the appropriate ages for screening. Therefore, appropriate and important measures should be taken to educate women about the benefits of cervical cancer screening tests.

1. Khanna Divya, Khargekar Naveen, Budukh Atul. Knowledge, attitude, and practice about cervical cancer and its screening among community healthcare workers of Varanasi district, Uttar Pradesh, India. Journal of Family Medicine and Primary Care,2019; 8(5):p 1715-1719.

2. Ezeama, Martin.C, Enwereji,E.E. Awareness of Cervical Cancer Screening test Among Women of Child Bearing age in the Rural Area of Awo-Omamma, Imo State, Nigeria.. International Journal of Health Statistics .2020; 1(1):1-6.

3. Manikandan S, Behera S, Naidu NM, Angamuthu V, Mohammed OFB, Debata A. Knowledge and Awareness Toward Cervical Cancer Screening and Prevention Among the Professional College Female Students. J Pharm Bioallied Sci. 2019 May;11(Suppl 2):S314-S320. 

4. Singh E, Seth S, Rani V, Srivastava DK. Awareness of cervical cancer screening among nursing staff in a tertiary institution of rural India. J Gynecol Oncol. 2012 Jul;23(3):141-6.

5. McCarey, C., Pirek, D., Tebeu, P.M. et al. Awareness of HPV and cervical cancer prevention among Cameroonian healthcare workers. BMC Women's Health 2011: 45.

6. Datchoua Moukam, A.M., Embolo Owono, M.S., Kenfack, B. et al. “Cervical cancer screening: awareness is not enough”. Understanding barriers to screening among women in West Cameroon—a qualitative study using focus groups.. Reprod Health 2021;18:147.

7. Medlineplus. Available at:  https://medlineplus.gov/cervicalcancerscreening.html (Accessed on 11 April 2023)

8. ACOG. Available at:   https://www.acog.org/womens-health/faqs/cervical-cancer-screening(Accessed on 14  April 2023)

9. Cancer. Available at:   https://www.cancer.net/cancer-types/cervical-cancer/ screening-and-prevention(Accessed on 14 April 2023)

10. WHO. Available at: https://www.who.int/data/gho/indicator-metadata-registry/ imr-details/3240(Accessed on 12 April 2023)

11. Cancer. Available at:    https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/how-diagnosed.html (Accessed on 12 April 2023)

12. CDC. Available at:    https://www.cdc.gov/cancer/cervical/ basicinfo/ screening. htm (Accessed on 13 April 2023)