Assessment of Women's Knowledge Regarding Cervical Cancer after Menopause in Mosul Teaching Hospitals

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Introduction

Cervical cancer is a worldwide issue. Breast cancer is the second most common malignancy in women under 45 and affects many women beyond 45. Globally, cervical cancer is the most common genital cancer. Menopause after cervical cancer treatment may be difficult owing to physical and mental side effects [1]. Menopause is the specific moment that occurs 12 months after a woman has had her last menstrual period. The period preceding menopause, characterized by potential alterations in women's menstrual cycles, hot flashes, and other symptoms, is referred to as the menopausal transition or perimenopause [2]. Menopause usually begins between 45 and 55. It usually lasts seven years but may last 14 years. Lifestyle variables including smoking, age of onset, and race/ethnicity might affect the condition's duration. Ovarian estrogen and progesterone production fluctuates greatly during perimenopause [3]. Each woman transitions to menopause differently. Metabolic changes affect energy use and fat cell function, making women more susceptible to weight gain. Your bone or heart health, body form, and physical function may change [4]. Cervical cancer is the fourth most frequent malignancy in women and the seventh globally, yet its effects vary. In poor nations, where 85% of the world burden lies, cervical cancer accounts for 12% of female cancers. HPV vaccination reduces the number of women who require follow-up and treatment for cervical cancer and genital warts. Cervix cancer. Upper vaginal extension. Chronic HPV infection causes 70% of cervical cancer globally [5]. Additional hazards encompass Cervical cancer is associated with early sexual initiation, several sexual partners, tobacco use, genetic predisposition, and weakened immune function. The predominant symptoms of cervical cancer were blood-stained vaginal discharge, post-coital bleeding, dyspareunia, post-menopausal hemorrhage, pelvic discomfort, inter-menstrual bleeding, weight loss, fatigue, and lumbar pain. Timely identification, intervention, and prophylaxis reduce cervical cancer mortality [5]. Screening and early treatment have drastically decreased cervical cancer mortality in numerous nations. The Pap smear has cut US cervical cancer deaths by 90%. HPV is one of the most common pathogens transmitted via sexual contact in the cervix. Cervical cancer requires persistent high-risk HPV infections [5]. The most common cause of cervical cancer is HPV infection, which causes 99% of squamous cell and adenocarcinomas. Despite being common among sexually active women, 90% of HPV infections recover without complications within a few years [6]. Following asymptomatic early stages, cervical cancer patients have atypical vaginal bleeding, pain, foul-smelling discharge, and dysuria. Cervical cancer is widespread in developing nations, where racial, regional, and economic disparities affect mortality [7]. The cervix contributes to 90% of human papillomavirus-related malignancies worldwide, with two-thirds in low- and middle-income countries [8]. The main risk factor for cervical cancer is persistent infection with one of the 15 high-risk HPV strains, with HPV-16 and HPV-18 accounting for 70% of cases. Having many sexual partners, being younger when having the first sexual encounter, getting married young, eating poorly, having a weakened immune system, and smoking are additional risk factors for HPV persistence and malignancy [9].

Over 30 years, cervical cancer screening has cut incidence by 50%. HPV misinformation and vaccination misinterpretation impact cervical cancer participation. Health education for cervical cancer primary prevention is routinely disregarded. Most cervical cancer is caused by one of 15 chronic HPV genotypes. HPV, duration of infection, host immunological response, environmental factors, and lack of annual cytology screening are connected to cervical cancer [10]. Multiple sexual partners, early sexual activity, and sex steroid hormone therapy are the biggest risks for cervical neoplasia, but earlier studies have shown that smoking, immunosuppression, and the human immunodeficiency virus may also contribute [11]. Lack of confidence in medical services, discrimination, Pap test anxiety or humiliation, and FGM are further difficulties. Higher education, marital status, work, children, and family size increase women's screening program participation [12]. The USPSTF updated its screening guidelines in 2018. The task force recommends Papanicolaou tests every three years for women 21–29, and triennial cytology or high-risk HPV testing every five years for women 30–65. The task force recommended triennial cytology for women 30–65 [13]. Over 70% of sexually active women and men will acquire the condition, and some may repeat it. At the onset of sexual activity, HPV infection rates are highest. Most infections resolve on their own within a few months, with 90% vanishing within two years [14]. The increased frequency of HPV-associated cervical dysplasia in immunosuppressed patients supports the hypothesis that local immune responses modify epithelial cells [15].

Study Design

This hospital-based, descriptive cross-sectional, analytical Study was carried out to accomplish the research objectives for the period from the period (from the1st. of October 2023 to the 30 March 2024).

Study Setting The data was collected from the outpatient departments or consulting clinics. The three hospitals and one health center in Mosul city (Al-Batool Teaching Hospital, Al-Khansa Teaching Hospital, Al-Salam Teaching Hospital, and primary health care center) the Nineveh Governorate, the second most important city in Iraq is in the northwest region of Iraq.

Study sample Simple random sampling was used for selecting the sample of the study from the outpatient departments, a total number of (150) women were divided into (52) from Al-Batool teaching hospital, (45) from Al-Khansa Teaching Hospital, and (39) from Al-Salam Teaching Hospital, and (14) from primary health care center (PHCC).

Tool of the Study Data were collected depending on an interviewing questionnaire composed of three parts. The first one focused on the socio-demographic characteristics. of study participants (woman's age, place of birth, marital status, residence, academic achievement, function, husband's profession, family history of cancer, whether or not the woman has cancer, Educational programs about cancer, source of medical information), the second part composed of 10 questions which focused on participants profile (menarche, Regularity of the cycle, Duration of period, Length of the process, family history of cancer, educational programs, source of information, number of births, number of children) and the third part composed of 11 questions which focused on the general information of post-menopausal about cervical cancer.

Data analysis

To describe and analyze the study's findings, the SPSS version (26) was used to analyze the data.

Results

Table 1: Socio-demographic characteristics of women for knowledge about cervical cancer Variable Category N Percent Age Group Place of birth Home 94 62.7% Hospital 47 31.3% Other 9 6.0% Marital Status Married 112 74.7% Single 9 6.0% Widow 23 15.3% Divorced 6 4.0% Academic achievement Do not read or write 57 38% Elementary stage 59 39.3% Secondary stage 15 10.0% Graduate and postgraduate 19 12.6% Place of residence City 101 67.3 Village 49 32.7 Job Employee 20 13.3% Housewife 130 86.7% Husband’s job Employee 54 36% Worker 60 40% No husband 36 24% The present study included 150 menopausal women. The mean age of the patients was 55.72 ± 13.2 years. The demographic and clinical characteristics of the woman are given in (Table 1-4).

Table 2: Description of the study participants' profile Variables Categories N Percent Have you ever had cancer? Yes 3 2.0% No 147 98% Do you have a previous family history of cancer? Yes 45 30% No 105 70% Have you entered any educational programs about cervical cancer and its prevention?

Yes 6 4% No 144 96% What is the source of medical information? Social media 18 12% Television 27 18% Medical staffs 31 20.7% Society 74 49.3% What is the history of premature birth?

Yes, regular 99 66% No, it is not a regular 51 34% How long is the menstrual cycle?

More than 30 days 18 12% When did the menstrual cycle start?

Table 3: Women's information regarding cervical cancer Knowledge Question Answer N. % What is cervical cancer?

It is the uncontrolled growth of cells in the cervical region and other organs of the body 44 29.3% It is the growth of cells generally in the cervical region only 28 18.7% Uncontrolled cell growth in the cervical region and reproductive system only 46 30.7% Average growth of cells in the lower abdomen 9 6.0% Do not know 23 15.3% What is the prevalence of cervical cancer in the world?

Cervical cancer ranks first in the spread among women in the world 13 8.7% The ranks second in spread among women of the world 41 27.3% The ranks third in spread among women in the world 45 30% The ranks fourth in spread among women in the world 18 12% Why does this age group (40-80) affect more than others?

Lack of immunity 31 20.7% Change of hormones 44 29.3% Heredity 33 22% Which of the following knows is one of the symptoms of cervical cancer?

Irregular menstrual cycle 25 16.7% Increase vaginal discharge 15 10% Bleeding after intercourse 12 8% Difficulty urinating 9 6% Pelvic pain 34 22.7% Weight loss 6 4% Sleep disorder 1 0.7% What are the stages of cervical cancer?

Single stage and includes only cervix 26 17.3% Two stages include cervical cancer and bladder wall 40 26.7% Four stages start in the cervix and transport to include parts of the reproductive 43 28.7% and bladder wall and rectum Three stages include cervix only 20 13.3% What is the importance of clinical examination?

Early detection of the disease helps with treatment and increases the chance of recovery 92 61.3% Detection of stages of the disease does not help with healing 29 19.3% To avoid severe complications of a possible disease but does not help with recovery 14 9.3% What are the methods of diagnosing cervical cancer?

Pap smear &HPV test 63 42% Radiology and MRI only 43 28.7% When symptoms appear, only the doctor makes the diagnosis 20 13.3% the patient's feeling specific symptoms, he expects to be cancer 12 8% What are the symptoms that should see a doctor?

When unfamiliar symptoms of bleeding or pain appear 82 54.7% The visit is periodic to maintain health 32 21% Weight loss 19 12.7% Feeling uncomfortable 17 11.3% When is the periodic examination?

Every year 98 65.3% Every three years 31 20.7% Every five years 5 3.3% Every six years 6 4% Do not know 10 6.7% Which of the following knows is one of the right ways to prevent cervical cancer?

Take the vaccine 17 11.3% Follow-up of tests 65 43.3% Avoid smoking 23 15.3% What factors contribute to cervical cancer Sexually transmitted disease 32 21.3% HPV virus 37 24.7% Family history of cancer 39 26% Obesity 4 2.7% Do not know 5 3.% This table shows that question (9) was 65.3% yearly and question (4) 0.7% was sleep disorder.

Discussion

Cancer is progressively emerging as the predominant illness of the century, particularly cervical cancer, which has now become the fourth most prevalent gynecologic malignancy globally, following breast cancer, in terms of mortality among women. This illness arises at the squamocolumnar junction of the cervical canal. It often occurs in a region recognized for significant alterations throughout late fetal development, puberty, and the initial pregnancy (16). The current study sought to evaluate women's understanding about cervical cancer. The present research. The majority of women tested exhibited inadequate understanding regarding cervical cancer. The study on "knowledge regarding cervical cancer prevention" in India concluded that most of the surveyed females had a deficient understanding of cervical cancer (17). The research "Knowledge, Attitude Regarding Cervical Cancer and Early Detection by Pap Test" conducted at King Saud University revealed that, during the pre-program period, 88% of the women surveyed possessed inadequate understanding concerning the Pap test. This can be ascribed to the lack of a structured cervical cancer program (18).

Table 1: This table shows that most women who participated in this Study are from the age group (40-49), and most of the women birth at the home. Regarding marital status, most of them are married and live in a city. The high rate of academic achievement is in the elementary stage. Most women are housewives and their husband's jobs are workers, also most of the women who participate in the Study do not have cancer or a history of cancer in their families, and do not enter any educational program. Society is a source of information that takes the high rate of women participating in the Study. Of the women's information about their menstrual cycle most of them answered that the menstrual cycle regular; begins at 13- 15 years, last 4-5 days, and every 26-30 days. The high rate of birth by women is 5 births or more with 3-5 child in home. Table 2: description of the study participants' profile that include cancer, previous family history of cancer, enrolled in educational programs about cervical cancer and its prevention, source of medical information, previous birth, number of children are at home, menstrual cycle regular or not, long is the menstrual cycle, menstrual cycle start, and number of days of the menstrual cycle.

Table 3: The percentage of women that replied with a correct answer for the first question (what cervical cancer?) is 30.7% and considering the high rate among other answers for this question. The percentage of women that answer the question (what is the prevalence of cervical cancer in the world?) is 12% and does not consider the high rate between other answers. The percentage of women that answer the question (why does this age group (40-80) affect more than others?) is 28% and does not have a high rate among other answers. The percentage of women that answer the question (which of the following knows is one of the symptoms of cervical cancer?) is 24% and does not have a high rate among other answers. The percentage of women that answer the question (what are the stages of cervical cancer?) is 28.7% and considers a high rate among other answers. The percentage of women that answer the question (what is the importance of clinical examination?) is 61.3% and considers a high rate among other answers. The percentage of women that answer the question (what are the methods of diagnosing cervical cancer?) is 42% and considers a high rate among other answers. The percentage of women that answer the question (what are the methods of diagnosing cervical cancer?) is 42% and considers a high rate among other answers. The percentage of women that answer the question (what are the symptoms that should see a doctor?) is 54.7% and considers a high rate among other answers. The percentage of women that answer the question (when is the periodic examination?) is 3.3% and considers the lowest rate among other answers. The percentage of women that answer the question (which of the following knows is one of the right ways to prevent cervical cancer?) is 28% and does not have a high rate among other answers. The percentage of women that answer the question (what factors contribute to cervical cancer?) is 22% does not have a high rate among other answers.

Conclusions

Based on the discussion of results and their interpretations, the present study concluded that: 1. The highest knowledge rate is in women in the age group (40-49) who live in the city.

2. The majority of woman dose not enrolled in educational programs about cervical cancer and its prevention 3. The research reveals that most women know about cervical cancer from society.

4. The highest knowledge rate was among employees.

5. High academic achievement (graduate and postgraduate)

have a high knowledge rate about cervical cancer. 6. Women who live in the city have a high knowledge rate about cervical cancer 7. The Study has shown that women who have a family history of cervical cancer have a high knowledge rate about cervical cancer.