Impact Of Psychological Factors In Cervical Cancer Screening

Authored By:

Dr. Priya Ganesh Kumar

WHO | IARC | FOGSI Colposcopy Course Convenor

Chairperson Elect Oncology Committee

FOGSI 2021-23

India is home to 17 percent of the world’s population, yet we have nearly a quarter of the world’s cervical cancer cases (1). We also have some of the highest mortality rates and this is largely on account of the lack of awareness, lack of preventive measures and delays in screening, detection, and treatment of cervical cancer. This is unfortunate, as adherence to vaccination and screening guidelines is known to help with both the prevention, early detection and successful treatment of cervical cancer. As per these guidelines, screening with pap smear tests should begin from the age of 25, continuing every 3 years, and women over 30 should also be screened every 5 years with HPV test (2). If we do not take steps to expand screening and prevention efforts, the WHO predicts that India’s annual incidence of new cases will touch 225,000 a year by 2025 (3).

To tackle these challenges, it is important for us to understand and recognize the barriers to widespread screening for cervical cancer. Although socio-economic factors and lack of access to quality health care play a role in this problem, there are also psychological factors at play.

Psychological Barriers to Cervical Cancer Screening

As per the findings of a report published in the Indian Journal of Cancer and findings from other global studies, psychological and sociocultural factors often prevent women from undergoing routine screening (4). Some of these barriers include the following:

Embarrassment

Many women delay or avoid routine cervical screening tests because of anxieties about body image, low self-esteem, and private self-consciousness. In a survey that was reported by UK’s NHS, concerns about body shape, appearance of the vulva, and vaginal odor, were all causes of anxiety that resulted in many women delaying or avoiding screening (5).

Association of Screening With Sex

In many women, fear and anxiety about cervical cancer screening was also linked to rigid sexual cultural norms. These beliefs give rise to belief of virginity loss because of intrusive nature of screening procedure

Lack of Spousal Support

In many parts of India, the lack of family and spousal support works as a huge barrier to women getting screened or tested for cervical cancer. A qualitative study from the state of Tamil Nadu found that 50 percent of spouses are not cooperative, at times even preventing their wives from undergoing screening (6).

Cultural Taboos

Cultural taboos give rise to major psychological barriers in women, as some studies have found even discussing the subject of testing to be considered offensive or inappropriate (7). With such restrictive cultural norms, many women feel anxious and reluctant to reveal personal information on sexual activity or submit to gynecological screening tests. This can also be compounded by the gender of health care providers.

Fear

Any type of cancer screening touches of fundamental human issues, such as the fear of death or mortality. With cervical cancer screening there is an added layer as it also touches on the subject of reproduction or infertility. Many women therefore avoid screening as they are ill-equipped to cope psychologically and emotionally with the implications of testing. In addition, it raises a fear of diagnosed with cervical cancer.

Overcoming Barriers

Understanding and recognizing psychological barriers to cervical cancer screening is the first step to overcoming them. If you have concerns and anxieties about testing, make it a point to speak to counsellors and heath care professionals who you trust.

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