Date of Award

5-2019

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Teri Aronowitz

Second Advisor

Ling Shi

Third Advisor

Rosanna Demarco

Abstract

Objective: Women treated for cervical precancer have up to 30% higher risk of developing cervical cancer than women in the general population. An essential part of cervical cancer secondary prevention is follow-up of women who screen positive and/or are treated for precancerous lesions. The essence of follow-up is to identify and retreat any recurrent/persistent lesions. The objective of this study was to determine the predictors for follow-up among women with cervical precancer in Cameroon.

Methods: After receiving institutional review board approval, we conducted a five-year retrospective chart review of 755 women in Cameroon who screened positive for cervical precancer in 2013.

Results: Of the 755 women, 422 (55.9%) received same-day treatment/biopsy or returned for treatment/biopsy. A total of 333 (44.1%) were lost to follow-up immediately after their diagnosis. Of those who returned for treatment at a later date, the lesions of 160 (37.9%) women were found to have regressed spontaneously. Of the 344 treated, 180 (42.7%) had same-day treatment/biopsy and 164 (47.7%) were treated/biopsied after the initial visit. Women 30-39 were more likely to follow-up for initial treatment than women less than 30 (Adjusted OR=1.61, p=0.006, 95% CI 1.14-2.26) and women 40-49 were even more likely to show-up than women less than 30 (Adjusted OR=2.17, p<0.001, 95% CI 1.43-3.31).

For post-treatment follow-up, 205 (59.6%) had no follow-up, 93 (26.6%) had one follow-up, 46 (13.1%) had two or more follow-ups. Women aged 40-49 were two times more likely to be adherent than non-adherent to recommended follow-up compared to women aged less than 30 (Adjusted RRR=5.34, p=0.044, 95% CI 1.04-27.37). Women screened in mobile clinics were less likely to follow-up than those screened in stationary clinics (Adjusted OR=0.25, p=0.007, 95% CI 0.06-0.69).

Conclusion. The predictors most statistically significantly associated with follow-up among women with cervical precancer in Cameroon were age and site of screening. For women less than 30 years old positive for cervical precancer, emphasis on follow-up should be strongly highlighted.

Comments

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