The Delayed Diagnosis of Cervical Cancer in Low-Middle Income Countries (LMICs): A Scoping Review

Introduction Cervical Cancer (CC) is a significant public health concern worldwide. Low-and-middle-income countries (LMICs) bare 90% of the burden of CC morbidity and mortality due to delayed diagnosis of the disease which is preventable and curable if detected early. Vaccination campaigns and early screening have succeeded in reducing CC prevalence drastically in high-income countries (HICs), highlighting a gap of health inequities in LMICs. This review aimed at mapping factors associated with the delayed diagnosis (DD) of cervical cancer (CC) across LMICs. Methods A search across databases; Embase, Pubmed, Scopus, Web of Science and SCINHAL. ProQuest Dissertations and Ebsco between 2019 to 2024 was conducted. Two reviewers independently screened titles and abstracts followed by a full-text assessment to determine the final inclusion. Any disagreements were resolved through consensus. Data were extracted using a standardized form, and a narrative synthesis was performed. Results We retrieved 2116 studies, however only 40 studies (across 26 LMICs) met our inclusion criteria and were relevant to this review. Patient-related (individual) and health-system (institutional) delays are more prominent than community-related delays. Approximately 80% of studies suggested that low income and education are predominant individual factors that lead to delayed diagnosis of CC. 67.5% highlight the failure to recognise symptoms in these regions. In rural Africa and South Asia, transportation costs are a major factor. 58% of the studies suggested marital status as an associated factor but this was dependent on a community factor; husband’s awareness. Countries with better husband’s knowledge associate marriage with early detection. Institutionally, 47.5% of the studies evidenced the lack of national screening programs and the lack of skills, knowledge and training of healthcare workers as a factor to delayed diagnosis predominantly in Africa. Conclusions Low income and education, long distances, poor spousal awareness, absence of screening facilities and unskilled capacity impact CC’s delayed diagnosis. Context-specific solutions like; expanding awareness, building quality, culturally appropriate, decentralised screening infrastructures with health workforce capability and focus on socio-cultural barriers across regions is necessary to defeat CC in LMICs.