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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 159-160

Lost-to-follow-up for cervical cancer screening

1 Department of Gyn-Oncology and Obstetrics, Command Hospital, Kolkata, West Bengal, India
2 Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India

Date of Submission24-Feb-2021
Date of Decision01-Mar-2021
Date of Acceptance01-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
S P Somashekhar
Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_46_21

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How to cite this article:
Bhandoria G, Ahuja V, Somashekhar S P. Lost-to-follow-up for cervical cancer screening. Cancer Res Stat Treat 2021;4:159-60

How to cite this URL:
Bhandoria G, Ahuja V, Somashekhar S P. Lost-to-follow-up for cervical cancer screening. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Jun 21];4:159-60. Available from: https://www.crstonline.com/text.asp?2021/4/1/159/312106

Screening is a proven strategy to decrease the burden of cervical cancer. Most developed nations have been able to significantly reduce the incidence of cervical cancer with the effective implementation of screening programs, along with widespread vaccination against the human papillomavirus infection. However, low- and middle-income countries like India are still struggling to achieve acceptable rates of screening for cervical cancer.[1] Vidhubala et al. performed a small qualitative study to identify the barriers to follow-up of women who tested positive on initial screening for cervical cancer.[2] This study brings out interesting perspectives from the patients' point of view. The authors have also interviewed the health-care staff involved in the screening program as they tend to echo the patients' concerns.

However, the authors have not described the size of the cohort from which this study sample was selected. It is also not clear whether the reported non-compliance is only for the initial follow-up or includes patients who did not return for a follow-up for the specific treatments offered after a positive result. It would have been useful to include questions related to the “see-and-treat” strategy to understand the acceptance of this concept in the screened population.

Thus, despite the interesting perspectives offered by Vidhubala et al.'s study, the inherent drawbacks of a qualitative study persist. Hence, their results must be replicated in other similar studies before they can be applied to a larger population.[3] Moreover, the study presents the opinions of a very small proportion of women in the population, and a small sample size can make it difficult to obtain statistically significant results. The “fear of screening” and “fear of being diagnosed with cancer” have also been identified in other similar qualitative studies recently.[4],[5],[6],[7]

The authors have suggested some solutions to reduce the loss to follow-up, such as repeated phone calls and home visits.[8] However, most participants had expressed concerns about such repeated phone calls and home visits by health-care workers.

The key barriers identified in this study can be overcome by effective communication and by explaining the benefits of screening and follow-up to the community women. In addition, gaining their trust and involving their family members, especially their husbands, can also help to overcome these barriers.

Integration of other members of their community and properly explaining the entire screening process in the native language using audiovisual aids seem to be more viable options to enhance the receptivity of the community women for screening opportunities.

Screening and follow-up can be challenging in a developing country like ours. Although Vidhubala et al.'s study is a good initiative, more well-structured and robust studies are required in the future to derive any meaningful outcomes.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Vora KS, Saiyed S. Cervical cancer screening in India: Need of the hour. Cancer Res Stat Treat 2020;3:796-7  Back to cited text no. 1
Vidhubala E, Shewade HD, Niraimathi K, Dongre AR, Gomathi R, Ramkumar S, et al. Loss to follow-up after initial screening for cervical cancer: A qualitative and descriptive exploration of barriers in Southern India. Cancer Res Stat Treat 2020;3:700-7.  Back to cited text no. 2
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Ochieng PA. An analysis of the strengths and limitation of qualitative and 41 quantitative research paradigms. Probl Educ 21 Century 2009;13:13-8. Available from: http://oaji.net/articles/2014/457-1393665925.pdf. [Last accessed on 11 Mar 2021].  Back to cited text no. 3
Dsouza JP, Van Den Broucke S, Pattanshetty S, Dhoore W. Exploring the barriers to cervical cancer screening through the lens of implementers and beneficiaries of the national screening program: A multi-contextual study. Asian Pac J Cancer Prev 2020;21:2209-15.  Back to cited text no. 4
Mahalakshmi S, Suresh S. Barriers to cancer screening uptake in women: A qualitative study from Tamil Nadu, India. Asian Pac J Cancer Prev 2020;21:1081-7.  Back to cited text no. 5
Khanna N, Phillips MD. Adherence to care plan in women with abnormal Papanicolaou smears: A review of barriers and interventions. J Am Board Fam Pract 2001;14:123-30.  Back to cited text no. 6
Devarapalli P, Labani S, Nagarjuna N, Panchal P, Asthana S. Barriers affecting uptake of cervical cancer screening in low and middle income countries: A systematic review. Indian J Cancer 2018;55:318-26.  Back to cited text no. 7
[PUBMED]  [Full text]  
Acera A, Manresa JM, Rodriguez D, Rodriguez A, Bonet JM, Trapero-Bertran M, et al. Increasing cervical cancer screening coverage: A randomised, community-based clinical trial. PLoS One 2017;12:e0170371.  Back to cited text no. 8


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