# Reproductive and Sexual Predictors of Late-Stage Cervical Cancer Presentation in Lagos, Nigeria

## TL;DR

This study in Lagos, Nigeria, finds that being post-menopausal is the only reproductive or sexual factor significantly linked to late-stage cervical cancer diagnosis.

## Contribution

The study uniquely identifies menopausal status as a key predictor of late-stage cervical cancer in Nigeria, where such research is limited.

## Key findings

- 82.9% of cervical cancer patients in the study presented with late-stage disease.
- Post-menopausal women had a higher likelihood of late-stage cervical cancer diagnosis.
- Other reproductive and sexual factors did not significantly influence late-stage presentation.

## Abstract

Background

The impact of late-stage cervical cancer (CC) is huge in Nigeria and Sub-Saharan Africa. Several factors have been attributed to this late-stage presentation but studies that examined the contributory role reproductive and sexual factors play in the late-stage CC presentation are uncommon.

Objectives

This study aimed to identify reproductive and sexual factors contributing to the late-stage presentation of CC in Lagos, Nigeria.

Materials and methods

Records of 228 women with CC who presented to Lagos University Teaching Hospital between 2015 and 2019 were retrospectively reviewed and information on their reproductive, sexual, and clinicopathological characteristics was obtained for analysis. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 23.

Results

Most (82.9%) of the women with CC presented with a late-stage disease with the majority presenting at stage 2B (28.9%) and stage 3A (20.2%) diseases. Among all the reproductive and sexual factors examined, only being post-menopausal was significantly associated with the increased likelihood of presenting with late-stage CC (crude odd ratio (COR)=2.26, confidence interval (CI)=1.13-4.55, p=0.020 and adjusted odd ratio (AOR)=2.15, CI=1.05-4.38, p=0.035). Age of menopause (AOR=2.08. CI=0.74-5.85, p=0.166) and duration of menopause (AOR=0.14, CI=0.16-1.30, p=0.143) were not significantly associated with late-stage CC presentation. Similarly, total pregnancies conceived (COR=1.32. CI=0.63-2.76, p=0.464), parity (AOR=1.68. CI=0.82-3.42, p=0.157), total children alive (COR=1.34. CI=0.67-2.68, p=0.413), presence of polygamous marriage (COR=1.52. CI=0.50-4.62, p=0.456), total lifetime sexual partners (COR=1.48. CI=0.66-3.31, p=0.342), age at coitarche (AOR=2.21. CI=0.68-7.12, p=0.186), and first delivery (AOR=2.71. CI=0.31-23.72, p=0.367) did not significantly influence late-stage CC presentation.

Conclusion

Menopausal status of the woman was the only reproductive and sexual factor that significantly predicted the likelihood of late-stage CC presentation with post-menopausal women having an increased risk of presenting with late-stage disease. There is a need for interventions to increase CC screening rates and improve health awareness and education about CC among post-menopausal women in Nigeria.