Temporal trends in cervical cancer screening participation, barriers, HPV infection, and cytopathological profiles before, during, and after the COVID-19 pandemic in Cameroon

Cervical cancer is a disease that begins with changes in the cells of the cervix, the lower part of the uterus. These changes are almost always caused by a common virus called human papillomavirus, or HPV, which spreads through intimate contact. In many parts of the world, this cancer is preventable. Doctors can find the early cell changes before they turn into cancer through a simple test called a Pap smear, where a small sample of cells is taken and examined under a microscope. If found early, these changes can be treated easily. However, in many low-income countries, including Cameroon, the disease remains a major health challenge because many women never get these tests. The reasons are complex, ranging from the cost of the test and the distance to a clinic to deep-seated fears and cultural beliefs about the body and medicine.

A team of researchers in Cameroon set out to understand exactly what is happening with cervical cancer screening in their country, looking at the years leading up to, during, and after the global pandemic that began in 2020. They gathered information from nearly 3,800 women between the ages of 25 and 65, recruited from both cities and rural villages across five different regions. The goal was not just to count how many women were getting tested, but to listen to their stories, understand their fears, and see what was happening with the virus and the cells in their bodies over time. The researchers wanted to know why so many women had never been screened, how the pandemic affected their ability to get care, and whether the patterns of infection were changing.

The study revealed a stark divide between city and country life. While the researchers intentionally recruited an equal number of women from urban and rural areas to make a fair comparison, the results showed that women living in rural areas were far less likely to have ever had a screening test. In fact, the vast majority of women in the study, particularly those in rural settings, reported that they had never undergone a cervical cancer screening in their lives. When the researchers looked at the timeline, they saw that the number of women getting screened dropped noticeably in 2020 and 2021, the height of the pandemic, before starting to climb again in the following years. This dip suggests that the global health crisis disrupted the routine medical care that women rely on, even though the study design means they cannot say for certain that the pandemic was the sole cause of the drop.

Beyond the numbers, the researchers listened closely to the women to understand the barriers standing in their way. The most powerful obstacles were not just about money or distance, but about fear and belief. A very large number of women expressed a deep fear of the gynecological examination itself, worrying about the pain or the intrusion. Many others were afraid of what neighbors or family might think if they were seen going for a test, or they held beliefs that cancer was caused by spiritual forces rather than a virus, leading them to prefer traditional healers over doctors. During the pandemic, new fears emerged, such as the worry of catching the virus while in a hospital or the loss of income that made seeking care impossible. The data showed that women who were afraid of the exam, who did not have health insurance, or who preferred traditional medicine were significantly more likely to have never been screened.

When the researchers examined the women's health samples, they found that the virus responsible for cervical cancer was still very much present. They tested for specific types of HPV and found that the most common dangerous types were still circulating, with the virus being detected in a significant portion of the women. They also looked at the cells under a microscope and found that some women had early signs of cell changes that could lead to cancer if left untreated. The study noted that while high-grade lesions were more common among those who had never been screened, the data did not show a statistical link between never having been screened and low-grade cell changes (LSIL). The researchers noted that the types of virus they found matched what is known to be dangerous in other parts of Africa, reinforcing the need for effective testing and treatment.

The study also took a hard look at the medical facilities themselves. The researchers visited different types of health centers, from small village clinics to large regional hospitals. They found a clear gap in resources: the large hospitals in cities were equipped with the tools needed to screen for cervical cancer and had trained staff ready to perform the tests. In contrast, the smaller health centers in rural areas often lacked the necessary equipment and trained personnel. This physical absence of services in the countryside helps explain why rural women are left behind. It is not just that they are afraid or unwilling; often, the service simply does not exist where they live.

The researchers were careful to explain what their study could and could not prove. Because they looked at different groups of women at different times rather than following the same women for years, they could describe patterns and associations but could not definitively prove that one thing caused another. For instance, while they saw a drop in screening during the pandemic, they acknowledged that other factors, such as changes in who was recruited or where the study was taking place, could also play a role. Similarly, while they found that fear and poverty were linked to not getting screened, they emphasized that these are complex, intertwined issues that require a broad solution. The study did not find that the virus itself was changing in a way that made it more dangerous, but rather that the human systems designed to catch it were struggling.

Ultimately, the picture that emerges is one of a preventable disease that continues to thrive because of a mix of fear, poverty, and a lack of accessible care. The researchers concluded that to fix this, Cameroon needs a strategy that goes beyond just building more clinics. It requires making screening affordable, bringing services closer to rural villages, and, perhaps most importantly, addressing the deep cultural fears and misconceptions that keep women away. The pandemic highlighted how fragile these systems are, but the path forward involves building a network of care that is not only available but also trusted and welcoming to every woman, regardless of where she lives or what she believes. The data shows that when women are scared or poor, they do not get tested, and when they do not get tested, the disease finds them. Breaking this cycle requires a solution that touches every part of their lives.