Risk Factors For Cervical Cancer In Ghana

Yvonne NARTEY, University of Otago, New Zealand
COX B. 1 , HILL P. 2 , ANTWI A. 3 , ASMAH R. 4 , NYARKO K. 5 , YARNEY J. 6 , DAMALE N. 7

1 Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
2 Centre for International Health, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
3 Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
4 Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
5 Disease Control and Prevention Department, Ghana Health Service, Accra, Ghana
6 National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
7 Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.

Purpose
To study the risk factors associated with cervical cancer in Ghana.
 
Methods
Incident cases of histologically confirmed invasive cervical cancer were identified in two large hospitals where most of cervical cancer cases are diagnosed and treated. Inclusion criteria for controls included no past or current history of cervical cancer, aged 18-95 years, residence in Ghana for at least three years, not vaccinated for HPV and disease not related to cervical cancer. Questionnaires were administered to the women after which a request for a cervical smear was made for reporting of cytological abnormalities and laboratory detection of HPV DNA and genotypes. Age, age at first marriage, region of residence, ethnicity and the presence of high-risk HPV were identified as confounding variables.
 
 
Results
Overall, 206 cases and 230 controls were recruited. HPV DNA testing was performed for 84 cases and 174 controls. The prevalence of HPV was 80.9% and 52.3% among women with and without cervical cancer respectively. Parity was a risk factor in this study (OR for 5 or more children = 7.88; 95% CI: 2.25-27.56). The risk increased with number of children (p for trend <0.001). Women reporting the use of a homemade sanitary towel during menstruation showed a seven-fold increased risk of cervical cancer compared with a pad (OR: 7.34; 95% CI: 2.45-21.98). Lack of genital hygiene and the use of OC were associated with the risk of cervical cancer.
 
 
Conclusions
High parity and poor personal hygiene were the main contributory risk factors, after high-risk HPV positivity. These results will be used to inform policy decisions around the implementation of HPV testing for screening and changes to lifestyle in Ghanaian women.
 
 
Funding source
The Director’s Cancer Research Trust, Hugh Adam Cancer Epidemiology Unit, and the Department of Preventive and Social Medicine, University of Otago, New Zealand, provided funding.