article · The Oncologist
Zambia experiences the third highest cervical cancer incidence globally, making it the principal cause of cancer death among women in the country. This study investigates the care journey of women with and without HIV who accessed cervical cancer screening and precancer treatment across urban, peri-urban, and rural areas. Researchers conducted focus group discussions with screened women and interviews with healthcare staff in public facilities. The care pathway comprised five stages: recognising the need to screen, hesitation and consultation, screening, interpreting results, and undergoing treatment. Although women were typically well informed and sought care promptly, fears caused delays for some. Support from social networks and healthcare professionals assisted screening uptake. Conversely, timely diagnosis and treatment were impeded by financial and logistical hurdles, as well as delays in histopathology services, particularly within rural healthcare settings.
Cervical cancer is a leading cause of death for women in Zambia. By mapping the full screening and treatment pathway, this work identifies the personal, social, and structural barriers that prevent women from receiving timely diagnosis and care, providing actionable guidance to improve public health delivery.
The findings inform operational improvements for public health programmes, diagnostic providers, and clinical training organisations. Interventions could include decentralised diagnostic services, expanded histopathology capacity, and structured healthcare communication tools. These insights reflect applied health systems research ready to guide service delivery reforms and policy implementation, though direct commercial applications are not explicitly detailed in the abstract.
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BACKGROUND: Zambia has the third highest cervical cancer incidence rate globally, and it remains the leading cause of cancer-related death among women. We explored the experiences of Zambian women who accessed cervical cancer screening and precancer treatment services to understand factors influencing care-seeking and access across urban, peri-urban, and rural settings. METHODS: In 2020, we conducted eight focus group discussions with women living with and without Human Immunodeficiency Virus (HIV) who underwent cervical cancer screening between 2016 and 2020. To explore their care journey, participants were grouped by screening outcome-those with cervical precancerous lesions and those without. We also conducted 18 in-depth interviews with healthcare workers providing antiretroviral treatment, cervical cancer screening, or precancer treatment at government health facilities. Transcripts were coded and analyzed using thematic analysis. RESULTS: Care-seeking unfolded across five stages: recognition of need to screen, hesitation and consultation, screening, result interpretation, and treatment. Women were generally knowledgeable about cervical cancer and sought screening promptly, though some delayed due to fear. Social networks and interactions with healthcare workers facilitated screening, while logistical and financial barriers, along with delays in histopathology services particularly in rural areas, hindered access to timely diagnosis and treatment. CONCLUSION: Improving cervical cancer screening and precancer treatment in Zambia requires addressing systemic inefficiencies by strengthening laboratory capacity, decentralizing diagnostics, and training healthcare workers to provide respectful, consistent counselling. Expanding community engagement to counter misinformation, leveraging social networks, and providing financial protection are also critical to ensuring timely, equitable, and reassuring care.
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DOI: 10.1093/oncolo/oyaf412
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