# Social Determinants of Health Impact Cervical Cancer Stage at Presentation among Women in Zambia

## TL;DR

This study explores how social factors, like awareness of cervical cancer risks, affect the stage at which women in Zambia are diagnosed with cervical cancer.

## Contribution

The study identifies lack of awareness about cervical cancer risks and symptoms as a novel factor associated with advanced cancer stage at presentation in Zambia.

## Key findings

- Lack of knowledge about cervical cancer risks and symptoms was significantly associated with advanced cancer stage (OR = 1.79).
- Standard social determinants like education and housing were not linked to advanced cancer stage.
- Improving awareness through education could reduce late-stage cervical cancer presentations.

## Abstract

The impact of social determinants of health (SDOH) on cervical cancer stage in Zambia remains poorly understood and understudied.

We administered the Accountable Health Communities Health-Related Social Needs Screening Tool, modified for Zambian culture, to newly diagnosed cervical cancer patients at the Cancer Diseases Hospital (CDH) in Lusaka, Zambia. The primary aim of the study was to determine the relationship between sociodemographic factors, SDOH domains, and advanced cervical cancer stage (III/IV) at presentation to CDH. Logistic regression models were performed to determine associations.

Between June 2022 and March 2025, there were 259 survey respondents. Their median age was 50 years (range: 29–78), 47.1% of them were diagnosed with advanced cervical cancer, 55.2% were women living with HIV, and most (92.6%) had completed primary or secondary education. Although none of the standard SDOH domains including education, housing, transportation, and rurality were associated with advanced cancer stage, lack of knowledge about cervical cancer risks and symptoms (OR = 1.79, 95% CI: 1.03–3.11; p = 0.04) was the main factor associated with advanced cervical cancer stage in the adjusted model.

Awareness about risks and symptoms of cervical cancer was the only factor associated with advanced cancer stage at presentation. While additional studies are needed to understand how SDOH may contribute specifically to cervical cancer prevention and diagnostic services access in low- and middle-income countries, improving educational strategies to increase awareness of the importance of screening and early diagnosis could reduce late-stage cervical cancer presentations.

We observed a significant association between awareness of cervical cancer risks and symptoms and FIGO stage which provide new insights that could benefit further research and practical application as we determine the best interventional strategies to test in the future. We believe these findings advance the field by addressing critical epidemiologic gaps and offering evidence to guide targeted strategies for health education and screening programs.