Assessing Participation of Women in a Cervical Cancer Screening Program in Peru

OBJECTIVE: To assess systemic and individual factors influencing participation of women in a screening program for cervical cancer. METHODS: In November 2000, a new cervical cancer screening program was introduced in the Region of San Martin, Peru. A total of 107 683 women, ages 25-49, were eligible for screening. This report covers the initial period from program inception through 31 October 2003. We used data from the program information system to identify systemic factors and individual characteristics influencing women's participation. We conducted a three-step analysis: we assessed systemic factors at the level of micronetworks or group of health centers, we estimated the odds of being a new user (never screened or not screened in the past 5 years) according to sociodemographic characteristics, and we assessed how women learned about the availability of screening services while controlling for influential factors identified in previous analyses. RESULTS: During the 3-year period, 36 759 eligible women attended screening services, for a participation rate of 32.3%. While attendance varied by area and time period, the program attracted 12 208 new users. Health care micronetworks with available static screening services had higher participation. New users were more likely than regular users to have less education and to report low use of family-planning services. All other factors being equal, they were also more likely than regular users to hear about screening services from a health care provider. CONCLUSION: In this setting, the presence of and contact with health services played a role in increasing the participation in screening of women not previously screened or not screened in the past 5 years.

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Promoting Quality of Cervical Cancer Screening and Treatment in India
(World Bank, Washington, DC, 2015-03) Krishnan, S.; Madsen, E.; Porterfield, D.; Varghese, B.
Cervical cancer screening is highly cost effective, feasible, and culturally acceptable in higher and lower income settings across the world. According to the World Health Organization and the World Economic Forum, screening for cervical cancer is an evidence-based best buy prevention intervention (1). However, to be effective in reducing cervical cancer incidence and mortality, screening programs must be of high quality. Cervical cancer is the second most common cancer among women in India. In 2010, nearly 74,000 Indian women were newly diagnosed with the disease and 34,000 women died (2). Recognizing the challenge of cervical cancer in India, the World Bank published a review of research on cervical cancer prevention and implementation experiences of cervical cancer screening programs in the country (3). The review found that program effectiveness depends on the quality of screening interventions. Cervical cancer screening programs are effective when they achieve high coverage of the target population, ensure high rates of follow-up of women who screen positive, and provide services consistent with established standards and guidelines. Screening program quality, shaped by several factors described below, influences these outcomes.
Advancing Cervical Cancer Prevention in India : Insights from Research and Programs
(World Bank, Washington, DC, 2013-10) Krishnan, Suneeta; Madson, Emily; Porterfield, Deborah; Varghese, Beena
Cervical cancer is the leading cause of cancer mortality in India, accounting for 17 percent of all cancer deaths among women age 30 to 69 years. At current incidence rates, the World Health Organization (WHO) estimates that the annual burden of new cases in India will increase to nearly 225,000 by 2025. Despite the considerable burden of cervical cancer morbidity and mortality in India, there are few large-scale, organized cervical cancer prevention programs in the country. We reviewed the research literature and conducted interviews with individuals engaged in research and public health program implementation to identify important elements of cervical cancer prevention efforts in India and implementation issues that merit further investigation. Although primary prevention through HPV vaccination has been endorsed by WHO, under certain conditions, in low- and middle-income countries (LMICs), its cost, partial efficacy and safety have been intensely debated in India. Further research and advocacy efforts are needed to determine the optimal strategies for its introduction and sustained use in the country. However, there is considerable research and programmatic evidence in support of secondary prevention of cervical cancer through screening and treatment. Regardless of screening approach, research and prevention programs have underscored the importance of ensuring strong linkages between screening, diagnosis, and treatment services for program and cost effectiveness. Available evidence also emphasizes that programs that are 'women-centered,' or actively respond to women's concerns and constraints are likely to be the most successful. In conclusion, research and prevention program experiences provide a strong rationale for investments in cervical cancer prevention in India.
Public Policy and the Challenge of Chronic Noncommunicable Diseases
(Washington, DC: World Bank, 2007) Adeyi, Olusoji; Smith, Owen; Robles, Sylvia
Since the early 1990s, the importance of chronic non-communicable diseases (NCDs) to global health has gained increased recognition. This report contains an agenda for action in response to the growing economic, social, and health problems posed by NCDs. Its objective is to enable the World Bank and its clients to examine and, where appropriate, strategically shift their approaches to public policy as a tool to prevent and control NCDs. The report highlights two broad themes. First, public policies need to prevent NCDs to the greatest extent possible and, in doing so, promote healthy aging and avoid premature deaths. Second, at the same time, public policies need to recognize that the burden of NCDs will increase because of population aging, and therefore public policy has a role to play in dealing with the pressures that this will impose on health services. Thus the report has a dual purview: how to avoid the burden of NCDs as much as possible and how to prepare for the consequences of more NCDs associated with demographic change.
Promoting Healthy Living and Aging in Central America : Multi-sectoral Approaches to Prevent Chronic Noncommunicable Diseases
(World Bank, Washington, DC, 2012-03) Bonilla-Chacin, Maria Eugenia; Vásquez, Luis T. Marcano
Non-communicable diseases (NCDs) are the main cause of death and disability in Central America. However, communicable diseases and maternal and child conditions remain important causes of death and disability as well as injuries. With the aging of the population and improvements in the control of infectious diseases, the share of NCDs in the total burden of disease is likely to increase. However, in Central America these diseases cause death at a much younger age than in higher-income countries. It is critical to prevent and control NCDs, both for their impact on health, as well as the economy. When not controlled, they can cause costly hospitalizations and large productivity losses due to absenteeism, disability and premature deaths. Finally, they can impoverish households hit by out-of-pocket payments for health services and drugs. A large share of NCDs can be prevented since they result from exposure to health risk factors such as unhealthy diets, physical inactivity, tobacco use, and the harmful use of alcohol. Central Americans have very high caloric diets that are rich in sodium and refined sugars, and lifestyles that often involve low levels of physical activity. Similarly, large shares of youth in some of the countries smoke, while alcohol consumption among drinkers and the frequency of binge drinking in Nicaragua and Guatemala are very high. Although all countries in the region have introduced multi-sectoral interventions to prevent NCD risk factors, much remains to be done: for example, countries have been more successful controlling smoking than addressing physical inactivity, alcohol abuse and poor diets. The role of the health sector is central to preventing NCDs: It needs to ensure their surveillance, along with the risk factors. In addition, the sector needs to ensure that effective multi-sectoral efforts to prevent these conditions take place.
Advancing Cervical Cancer Prevention in India
(World Bank, Washington, DC, 2015-03) Krishnan, S; Madsen, E.; Porterfield, D.; Varghese, B.; Poehlman, J.; Taylor, O.
In 2010, nearly 74,000 new cases of cervical cancer were diagnosed among Indian women. This number is estimated to increase to as high as 225,000 cases by 2025. Cervical cancer is also the leading cause of cancer deaths in India, as most cases are not detected until they are in an advanced stage. In addition to the cost in lives, cervical cancer can have a significant social and economic impact on families and their communities, as it primarily affects women during their most productive years. Recognizing the challenge of cervical cancer, in 2013 the World Bank conducted a review of research studies on cervical cancer prevention and examined the implementation experiences of cervical cancer screening programs in India. A recently published report summarizes the current state of knowledge and practice, and offers recommendations for strengthening India s programmatic and policy responses to cervical cancer.

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