Cervical cancer (CC) is caused by a sexually acquired infection with Human papillomavirus (HPV). Globally, this is the fourth most common cancer in women with an estimated 570,000 new cases and 311,000 deaths in 2018 (Arbyn, Weiderpass, Bruni, Sanjose, Saraiya, Ferlay et al., 2020). At the regional level, Cervical cancer is most common in Africa, with rates seven to ten times higher than in Australia, Western Asia, North America, and New Zealand (Bray, Ferlay, Soerjomataram, Siegel, Torre, Jemal, 2018). In low- and middle-income countries, CC is the second most common cancer and the major cause of death among women in low and middle-income countries, accounting for 88% of deaths (Bray et al., 2018). Nigerian women aged 15 and above who are at risk of developing cervical cancer are 50.33 million, 14943 women are diagnosed and 10403 died yearly (Bruni, Albero, Serrano, Mena, G´omez, Mu˜noz, Bosch, de Sanjos´e, 2019). The worrisome rise in adolescent and young adult patients with malignant epithelial malignancies of the cervix is alarming among patients aged 0–30 years old, especially 21–30 years age group (Abudu & Akinbami, 2016).
Cervical cancer is preventable worldwide through screening, detection, and treatment of precancerous abnormalities (Islam, Billah, Hossain & Oldroyd, 2017). Cervical cancer screening guidelines recommend that women between the ages of 21 and 29 should get a Pap test every three years; women between the ages of 30 and 65 should get an HPV test every five years or a Pap test every three years after consulting with their doctor; and those over the age of 66 should ask their doctors if they need continued screening testing every five year (US Preventive Services Task Force, 2018). According to projections, the burden of the disease will rise to nearly 460,000 deaths by 2040 if preventive services are not scaled up quickly (Bray et al., 2018).
Cervical cancer screening rates have declined in Western countries (Mayo Clinic, 2019), and among women between ages 45 and 65 in the United State ((Donatus, Nina, Sama, Nkfusai, Bede, Shirinde & Cumber, 2019). Screening uptake is declining in low-resource countries (Achampong, et al, 2018). In Nigeria, there is paucity of information on screening rate, but some studies conducted in parts of the country found that cervical cancer screening coverage by conventional cytology is less than 9% in the populace (Musa, Silas, Mehta., Murphy, & Hou 2019), 10.2% among Federal Civil Servants in North Central Nigeria (Hyacinth, Adekeye, Ibeh, and Osoba 2012), and 32.6% among health workers at JUTH and its environs (Eka, 2016). It was found that most cervical cancer cases (72.3%) are diagnosed at advanced stages(Musa, Nankat, Achenbach, Shambe, Taiwo, & Mandong, 2016). Women use cervical cancer screening services at a relatively late age, with a median age of 37 (Musa et al., 2019), 40–49 years (Egbodo, Edugbe, Akunaeziri, Ayuba, Oga, Shambe et al., 2018).
Low uptake may result from fear, embarrassment (Hahm, Choi, Lee, Suh, Lee, Shin et al., 2017; (Frerichs, Rhode, Bell, Hunt, Lowery, Brooks, et al., 2018; Alexis & Worsley, 2018; Nyambe, Kampen, Baboo, & Hal, 2018; Ifemelumma et al., 2019; Momberg, Botha, Van Der Merwe, & Moodley, 2017; Lor, Backonja & Lauver, 2017; Joffe, Ayeni, Norris, Mccormack, Ruff, Das, et al., 2018); Vhuromu. Goon, Maputle, Lebese, & Okafor, 2018), low socioeconomic status (US Preventive Services Task Force, 2018), unsatisfied previous screening experience (Al-Amoudi, Cañas, Hohl, Distelhorst, & Thompson, 2015; Al Dasoqi, Zeilani, Abdalrahim, & Evans., 2013), while experiencing gynaecological symptoms (Ndejjo et al., 2017; Momberg et al., 2017; Nyambe et al., 2018) may encourage participation.
Facilitating conditions for screening which were effective in some settings did not achieve their desired aim in other settings as found in these studies: free screening did not increase screening rate (Donatus et al., 2019), Availability of screening centres nears women homes (5km away from their homes) did translate to screening (Vhuromu et al., 2018), Educational interventions were not very effective overall (Mbachu Cyril, & Uche, 2017; (Lott, Trejo, Baum, McClelland, Adsul, Madhivanan et al., 2020, Economic incentivization interventions were moderately effective, increased uptake but still achieving less than 20% coverage ((Mehrotra, An, Patel and Sturm, 2014), very high willingness to screen, even pre-intervention, but that intent was not always well-translated to the uptake of cervical cancer screening ((Ndikom, Ofi, Omokhodion, Adedokun & Ndikom, 2017), increase from 75.8 to 91.0% in willingness to screen yet no change in actual screening (Lott et al., 2020), significant improvement in uptake without any community health educators (Chigbu, Onyebuchi, Onyeka, Odugu and Dim, 2017), pre-invitation leaflet nor online booking did not increase uptake by three months (18.8% pre-invitation leaflet vs. 19.2% control and 17.8% online booking vs. 17.2% control. The offer of a nurse navigator, a self-sample kit on request, and choice between timed appointments and nurse navigator were ineffective (Kitchener, Gittins, Cruickshank, Moseley, Fletcher, Albrow et al., 2018). Health talk did not affect practice (Yunitasari, Rosyda, & Santoso, 2020). In the absence of facilitating conditions, barriers to screening ensued.
To reduce the burden of cervical cancer, women must take up cervical screening services which will detect the presence of HPV to prevent precancerous cells from transforming to the cancerous cell especially in a country where human papilloma vaccine is not readily available and accessible. Effective CC screening interventions based on women's needs are a critical component of the prevention that will eventually reduce the global burden of in cervical.