# Cervical cancer awareness among women recently diagnosed with cervical cancer in South Africa and Zimbabwe

## TL;DR

This study found that many women recently diagnosed with cervical cancer in South Africa and Zimbabwe lack awareness of symptoms and risk factors, highlighting the need for better education to improve early diagnosis and prevention.

## Contribution

The study provides novel insights into cervical cancer awareness disparities between urban/rural areas and HIV status in Southern Africa.

## Key findings

- Only 46% of women could recall one or more cervical cancer symptoms, with significant variation between South Africa (24%) and Zimbabwe (76%).
- Higher education and urban/peri-urban residence in South Africa were associated with increased symptom awareness.
- Women in Zimbabwe with HIV were more likely to know risk factors compared to those without HIV.

## Abstract

Incidence and mortality rates of cervical cancer remain high in Southern Africa (SA). We explored awareness of cervical cancer symptoms and risk factors, as well as risk lay beliefs among women recently diagnosed with cervical cancer from SA and Zimbabwe. Patients were asked to complete a locally validated questionnaire with unprompted, open-ended questions to assess awareness of cervical cancer symptoms and risk factors. Among 501 women (SA 285, Zimbabwe 216), 46% (229) were able to recall one or more symptoms (SA 24%, Zimbabwe 76%) and 19% (93) were able to recall one or more risk factors of cervical cancer (SA 27%, Zimbabwe 73%). In SA, factors associated with increased symptom awareness included higher education level (completion of secondary education compared to not completing secondary education; adjusted odds ratios (aOR) 2.74, 95% confidence interval (CI) 1.17–6.43) as well as living in urban and peri-urban areas compared to living in rural areas (Urban: aOR 2.98, 95% CI 1.35–6.80; Peri-urban: aOR 3.28, 95% CI 1.13–9.35). Having a self-reported history of a chronic condition was associated with lower risk factor awareness compared to not having a self-reported chronic condition (aOR 0.07, 95% CI 0.00–0.42). In Zimbabwe, those who self-reported living with HIV were more likely to know one or more risk factors compared to those without HIV (aOR 2.69, 95% CI 1.31–5.67). Overall, 90 (18%) women mentioned at least one lay belief about risk factors for cervical cancer, with the most reported being inserting herbs, creams or objects into the vagina (9%, n = 43). The low levels of cervical cancer awareness in two Southern African countries highlight the urgent need to improve cervical cancer awareness, as low levels of awareness can impact timely cancer diagnosis and limit the uptake of cervical cancer prevention programs.