ogenesis &

c in

Journal of Carcinogenesis &

r
ur nal of Ca

Mu
Haque et al, J Carcinog Mutagen 2019, 10:4

tagenesis Mutagenesis
Jo

ISSN: 2157-2518

Research Article Open Access

Assessment of Knowledge on Cervical Cancer among Bangladeshi

Women: A Hospital Based Cross Sectional Study
Nabila Binte Haque1*, Arun Shahi2, Tajul Islam3 and Mollah Obayedullah Baki1
1
Department of Public Health, North South University, Dhaka, Bangladesh
2 Department of Medical Oncology, National Institute of Cancer Research and Hospital, Mohakali, Dhaka, Bangladesh
3Save the Children, Dhaka, Bangladesh
*Corresponding author: Nabila BH, Department of Public Health, North South University, Dhaka, Bangladesh, E-mail: [email protected]
Received: October 01, 2019; Accepted: October 17, 2019; Published: October 24, 2019
Copyright: © 2019 Nabila BH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: The aim of this study was to assess the level of knowledge of cervical cancer among Bangladeshi
women and to determine the source of information.

Methods: A total of 250 women aged 17 to 55 years, were interviewed using a structured questionnaire. It is a
population-based, cross-sectional survey which was conducted in a tertiary cancer hospital, National Institute of
Cancer Research and Hospital (NICRH), Mohakhali, Dhaka, Bangladesh from September 2017 to March 2018. Data
on socio-demographic characteristics, knowledge of cervical cancer and source of information were collected. The
bivariate analysis was completed using a quantitative data collected.

Results: The majority of our study participants reported to have very poor Knowledge about cervical cancer.
Mostly it is related with women’s low level of formal education, illiterate (OR: 5.653, 95% CI: 0.021-0.257, p
value<0.001). Very few women reported to have detailed knowledge about cervical cancer (Education above primary
level p value<0.001). Other factors associated with poor knowledge were Occupation (OR: 6.543, 95% CI:
2.213-19.206, p-value<0.001) monthly family income (p value<0.001), Husband’s education level (p value<0.001).
We found age of the women was significantly responsible for poor knowledge, women aged more than 40 years (p
value<0.005) old having cervical cancer were unaware about cervical cancer.

Conclusion: Knowledge about cervical cancer is found to be poor among Bangladeshi women, unlike findings in
developed countries. There is need to educate our women on the early warning signs of cervical cancer as failure to
recognize the early symptoms and signs contribute to the late presentation and poor prognosis.

Keywords: Cervical cancer; Knowledge; Bangladesh countries, women’s knowledge about risk factors of cervical cancer is
very limited. Throughout the world, prevention, control and treatment
Introduction of cervical cancer have been a public health priority. The world pattern
of cervical cancer indicates that this is predominantly a problem of
In Bangladesh Cervical cancer is the 2nd most common female low-resource setting countries. Unlike developed countries, cervical
cancer in women aged 15 to 44 years. It is estimated that 11,956 new cancer prevention programs have failed to meet their objectives in
cervical cancer cases were diagnosed in 2012 in Bangladesh [1]. developing countries due to financial, social and logistical problems
Whereas, cervical cancer is the fourth most common cancer among [6,7]. Among Bangladeshi women, there are very few studies done on
women in the world, with an estimated 528,000 new cases in 2012 [2]. in-depth knowledge on cervical cancer, such as risk factors or
Majority of cervical cancer occurs in women of under developed symptoms. Data on knowledge of cervical cancer among a more
countries. Cervical Cancer is predicted to be an increasingly important representative sample, including those residing in urban areas and
cause of morbidity and mortality in Bangladesh in the next few younger populations, are needed. Therefore, our study aims to assess
decades [3,4]. The estimated incidence of 12.7 million new cancer the knowledge and awareness of cervical cancer among Bangladeshi
cases will rise to 21.4 million by 2030. More than two-thirds of the women. We collected the samples between women who are suffering
total expenditure on health is through out-of-pocket payments. with Cervical Cancer [8-10].
According to the Bangladesh Bureau of Statistics, cancer is the sixth
leading cause of death. International Agency for Research on Cancer Methods
has estimated cancer-related death rates in Bangladesh to be 7.5% in
2005 and 13% in 2030 [4]. According to WHO, at least 30%-40% of all
cancer deaths are preventable and the rates are extending as more Study design
people live to an old age and as much lifestyle change originate in the We conducted a hospital based cross sectional study in tertiary
developing world [5]. Several factors have been attributable to cancer hospital, National Institute of Cancer Research and Hospital,
increased incidence of cervical cancer in Bangladesh such as early age (NICRH) Mohakhali, Dhaka during September 2017 to March 2018.
marriage, multiple marriages, high parity and illiteracy. In developing

J Carcinog Mutagen, an open access journal Volume 10 • Issue 4 • 1000341

ISSN: 2157-2518
Citation: Haque NB, Shahi A, Islam T, Baki MO (2019) Assessment of Knowledge on Cervical Cancer among Bangladeshi Women: A Hospital
Based Cross Sectional Study . J Carcinog Mutagen 10: 341.

Page 2 of 6

Study subjects were women with invasive cervical cancer and diagnosis participants. The completed questionnaires were collected on a daily
was confirmed with histopathology reports at the department of basis to check for its consistency and completeness. Data’s were entered
pathology of NICRH. All respondents were in a sufficiently good into Fox pro and analyzed using Statistical Package for Social Science
physical and mental condition to provide reliable answers [11,12]. (SPSS version 18). Percentage was calculated for all the variables.
Relevant tables and graphs were computed. Descriptive data analyses
Sample size were used to describe the knowledge factors for cervical cancer.
Different frequency tables, graphs and descriptive summaries were
The Study was conducted in 245 female Patients aged 17-55 years used to describe the variables [13-17].
old and who were admitted or attended NICRH for consultation.
Study variables
Sampling procedure
Dependent variables are knowledge of respondents towards cervical
It was a cross sectional interview based study. A quantitative cross cancer among Bangladeshi women. Independent variables are socio-
sectional descriptive design was used to conduct to assess the demographic related factors.
knowledge and attitude of cervical cancer among patients 17-55 years
old. The participants were all women who came for consultation or got
admitted into the hospital (NIRCH) for treatment. Participants were
Results
selected by convenience sampling method.
Socio demographic characteristics
Data collection Majority age groups (37.6%) were more than 40 years old with mean
Data collection took place among 250 patients in indoor and age 37.84 (Table 1). Almost all of the respondents were married
outdoor of National Institute of Cancer Research and Hospital (96.4%). Most of the respondents were Muslims (82.8%), few were
Mohakhali, Dhaka (NIRCH). Participant’s written informed consent Hindus and other religions (17.2%). Most of them were from a low
before participating and confidentiality and anonymity was ensured at socio-economic background (26.8). Respondent’s educational
every stage. Participation was voluntary and women were allowed to background was mostly illiterate or primary (74%) [18-23]. Majority of
withdraw from the research at any stage if they wish to, without having the women were housewives (86.4%). Only 26% had the background of
to give a reason. Data were collected on knowledge about cervical above primary education. The educational backgrounds of the
cancer, its socio-demographic factors and behavioral factors. husbands were mostly below primary level (55.5%). Most of them were
Questionnaire was designed based on the study subjects taking help from agriculture background (43.6%), 44% were from other
from the previous literature and study available on this topic. The occupation. 62.4% of respondents were living in rented houses where
questionnaire was completed after obtaining verbal consent from the as 37.6% respondents had their own houses [24-28].

Age of the women’s in years Frequency % Occupation of respondent Frequency %

<30 63 25.2 Housewife 216 86.4

31-40 93 37.2 Others 34 13.6

>40 94 37.6 Occupation of husband Frequency %

Mean (SD) 37.84 (10.542) Agriculture 109 43.6

Marital status Frequency % Others 141 56.4

Married 241 96.4 House condition Frequency %

Unmarried 9 3.6 Rent 156 62.4

Religion Frequency % Own 94 37.6

Muslim 207 82.8 Monthlyfamily income in taka Frequency %

Hindu 43 17.2 <25000 183 73.2

Type of family Frequency % >25000 67 26.8

Nuclear 55 22 Both male and female 62 24.8

Joint 195 78 Only males 2 0.8

Education of respondent Frequency % Only females 90 36

Illiterate+primary 185 74 Don’t know 96 38.4

Above primary 65 26 Mean (SD) 1.27(0.444)

J Carcinog Mutagen, an open access journal Volume 10 • Issue 4 • 1000341

ISSN: 2157-2518
Citation: Haque NB, Shahi A, Islam T, Baki MO (2019) Assessment of Knowledge on Cervical Cancer among Bangladeshi Women: A Hospital
Based Cross Sectional Study . J Carcinog Mutagen 10: 341.

Page 3 of 6

Education of husband Frequency % Cervicalcancer transmitted mostly by sexually Frequency %

Illiterate+primary 139 55.5 Yes 44 17.6

Above primary 111 44.4 No 206 82.4

Table 1: Socio-demographic Respondents characteristics.

Knowledge of women on cervical cancer cervical cancer. Almost half of the respondents had no idea about the
cause of this cancer (50%). Whereas 47.2% respondents had proper
The result shows that (Table 2) majority of women thinks that knowledge about the site of cervical cancer. Some even thought that it
cervical cancer is a disease (45.6%). Few of them also thought it is as a is a cancer of only males (36.0%).
curse from God (28.4%). Around 26% had no knowledge about

Knowledge Frequency %

Cervical cancer is:

A disease 114 45.6

Curse from God 71 28.4

Don’t know 35 26

Cause of cervical cancer

Caused by virus 35 14

Curse from God 90 36

Don’t know 125 50

Site of cervical cancer

Uterus 6 2.4

Vagina 118 47.2

Bladder 46 18.4

Abdomen 80 32.0

Sufferers of cervical cancer

Both male and female 62 24.8

Only males 2 0.8

Only females 90 36.0

Don’t know 96 38.4

Cervical cancer transmitted mostly by sexually

Yes 44 17.6

No 206 82.4

Table 2: Frequency distribution of knowledge on cervical cancer.

Table 3 shows the association of knowledge with socio-demographic condition (OR:0.035, 95%, CI:0.011-0.012, p value<0.001) and member
and other factors. The bivariate analysis shows that knowledge about of family (OR: 0.207, 95% CI: 0.076-0.567, p value 0.002). Age was one
the cervical cancer was found to be associated with respondent’s poor of the significant factors for cervical cancer. Majority of respondent’s
education (OR: 5.653, 95% CI: 0.021-0.257, p value<0.001), occupation age was above 40 (p value<0.001). We found some other factors also
(OR:6.543, 95%, CI: 2.213-19.206, p value<0.001), monthly family significant like Husbands education (p value<0.001), occupation (p
income (OR: 5.073, 95% CI: 2.291-11.235 p value<0.001), house value<0.001), type of family (p value 0.001) [29-32].

J Carcinog Mutagen, an open access journal Volume 10 • Issue 4 • 1000341

ISSN: 2157-2518
Citation: Haque NB, Shahi A, Islam T, Baki MO (2019) Assessment of Knowledge on Cervical Cancer among Bangladeshi Women: A Hospital
Based Cross Sectional Study . J Carcinog Mutagen 10: 341.

Page 4 of 6

Background variable Categories variable Poor knowledge N (%) Good knowledge N (%) Total knowledge N (%) P-value

>30 36 (20.9) 27 (34.6) 63 (25.2)

Respondents age In years 31-40 66 (38.4) 27 (34.6) 93 (37.2) 0.027

Above 40 70 (40.7) 24 (30.8) 94 (37.6)

Married 170 (98.8) 71 (91.0) 241(96.4)

Marital status 0.005
Unmarried 2 (1.2) 7 (9.0) 9(3.6)

Muslim 129 (75.0) 78 (100) 207 (82.8)

Religion 0
Hindu 43 (25.0) 0 43 (17.2)

Housewife 159 (73.6) 57 (26.4) 216 (86.4)

Respondent occupation 0
Others 13 (38.2) 21 (61.8) 34 (13.6)

Illiterate+Primary 156 (90.7) 29 (37.2) 185 (74)

Respondents education 0
Above primary 16 (9.3) 49 (62.8) 65 (26)

Agriculture 96 (55.8) 13 (16.7) 109 (43.6)

Husbands occupation 0
Others 76 (44.2) 65 (83.3) 141 (56.4)

Illiterate+Primary 110 (79.1) 29 (20.9) 139 (55.6)

Husbands education 0
Above primary 62 (55.9) 49 (44.1) 111 (44.4)

≤ 25000 153 (89.0) 30 (38.5) 183 (73.2)

Monthly income 0
≥ 25000 19 (11.0) 48 (61.5) 67 (26.8)

≤ 4 members 34 (19.8) 26 (33.3) 60 (24)

Family member 0.016
>4 members 134 (18.2) 52 (66.7) 186 (74.4)

Own house 84 (48.8) 72 (92.3) 156 (62.4)

House condition 0
Rented house 88 (51.2) 94 (37.6) 182 (72.8)

Nuclear 25 (14.5) 30 (38.5) 55 (22)

Type of family 0
Joint 147 (85.5) 48 (61.5) 195 (78)

Table 3: Association of socio-demographic characteristics with poor knowledge.

Sources of information While TV/radio (39%), Newspaper (30.9%) and internet (22.3%)
were other sources of information. Mother (2.6%), sister (13%) and
Doctors or hospital staffs (62.1%) were the most important source of Friends (8.6%) could be also information.
information (Chart 1).
Discussion
From our result we observed that there is a significant association of
illiteracy with poor knowledge about cervical cancer. Those whose
education level was above primary had better knowledge (62.8%) than
education level below primary or illiterate (38%). This relation between
education and knowledge has also been reported in previous studies in
Arab and Hispanic women.
People with below primary level second common age group with
Chart 1: Source of Information. poor knowledge was from 31 to 40 years old with 34.6% knowledge.
Very few women were below 30 and they had poor knowledge about
20.9% [33-35]. Age also showed significant relation associated with
knowledge with cervical cancer. Ninety eight percent of married
women had poor knowledge about cervical cancer. Previous studies

J Carcinog Mutagen, an open access journal Volume 10 • Issue 4 • 1000341

ISSN: 2157-2518
Citation: Haque NB, Shahi A, Islam T, Baki MO (2019) Assessment of Knowledge on Cervical Cancer among Bangladeshi Women: A Hospital
Based Cross Sectional Study . J Carcinog Mutagen 10: 341.

Page 5 of 6

have shown that low level of education and low socioeconomic status Hubli, Karnataka, India. Int J Community Med Public Health 3:
are responsible for increasing incidence of cervical cancer. Future 2579-2583.
research is needed to explore the level of knowledge of cervical cancer 9. Islam JY, Khatun F, Alam A, Sultana F, Bhuiyan A, et al. (2018)
in other populations at high risk. There is a clear need of sharing Knowledge of cervical cancer and HPV vaccine in Bangladeshi women: A
population based, cross-sectional study. BMC Women's Health 18: 15.
information of cervical cancer through education and educational
campaigns. Had very poor knowledge. Most of the respondent’s 10. Geremew AB, Gelagay AA, Azale T (2018) Comprehensive knowledge on
cervical cancer, attitude towards its screening and associated factors
husband’s education was also either illiterate of below primary. They
among women aged 30–49 years in Finote Selam town, northwest
literally had no idea about this cancer. In this study we also observed Ethiopia. Reprod Health 15: 29.
that age, marital status, level of occupation, monthly income, family
11. Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor
member and house condition were significantly associated with factors F, et al. (2016) Cervical cancer prevention and treatment research in
affecting the knowledge on cervical cancer. Majority of respondent’s Africa: A systematic review from a public health perspective. BMC
age was above 40 and they had only 30.8% knowledge about cervical Women's Health 16: 29.
cancer [36-39]. 12. Siddharthar J, Rajkumar B, Deivasigamani K (2014) Knowledge,
awareness and prevention of cervical cancer among women attending a
tertiary care hospital in puducherry, India. J Clin Diagnostic Res 8: 1-3.
Conclusion
13. Darlin L (2013) Cervical cancer studies on prevention and treatment.
This study provides the probably first hospital-based assessment of Lund University Libraries 142 : 42-52.
knowledge about cervical cancer among Bangladeshi women. The 14. Haque N, Uddin AF, Dey BR, Islam F, Goodman A (2017) Challenges to
findings from this study provide the necessary country-specific cervical cancer treatment in Bangladesh: The development of a women's
evidence for the development of cervical cancer awareness program. cancer ward at Dhaka Medical College Hospital. Gynecologic Oncol Rep
21: 67-72.
Low levels of awareness of cervical cancer, in-depth knowledge of
causes of cervical cancer and how it can be prevented is alarming sign 15. Ramathuba DU, Ngambi D, Khoza LB, Ramakuela NJ (2016) Knowledge,
attitudes and practices regarding cervical cancer prevention at Thulamela
for the health of women. These findings underscore the necessity for Municipality of Vhembe District in Limpopo Province. Afr J Prim Health
culturally appropriate and targeted educational interventions to Care Fam Med 8: 1-7.
improve knowledge of cervical cancer causes and its primary 16. Nwankwo KC, Aniebue UU, Aguwa EN, Anarado AN, Agunwah E (2011)
prevention measures. Knowledge attitudes and practices of cervical cancer screening among
urban and rural Nigerian women: A call for education and mass
Acknowledgement screening. Eur J Cancer Care. 20: 362-367.
17. Aweke YH, Ayanto SY, Ersado TL (2017) Knowledge, attitude and
The authors are grateful to the, Director of National Institute of practice for cervical cancer prevention and control among women of
cancer research and hospital (NICRH) Professor Dr. Md. Moarraf childbearing age in Hossana Town, Hadiya zone, Southern Ethiopia:
Hossein and Professor Dr. Md. Yeakub Ali, Head of the department of Community-based cross-sectional study. PloS One. 12: 14-18.
Medical Oncology for cooperation and support during data collection. 18. World Health Organization (2006) Chronic Diseases, Health Promotion.
And special thanks to ethical committee of NICRH for giving us Comprehensive cervical cancer control: A guide to essential practice.
permission to conduct our research. WHO Press, Switzerland.
19. Bosch FX, Burchell AN, Schiffman M, Giuliano AR, de Sanjose S, et al.
(2008) Epidemiology and natural history of human papillomavirus
References infections and type-specific implications in cervical neoplasia. Vaccine 26:
1-16.
1. Mutambara J, Mutandwa P, Mahapa M, Chirasha V, Nkiwane S, et al.
(2017) Knowledge, attitudes and practices of cervical cancer screening 20. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, et al. (2015)
among women who attend traditional churches in Zimbabwe. J Cancer Cancer incidence and mortality worldwide: Sources, methods and major
Res Pract 4: 53-58. patterns in GLOBOCAN 2012. Int J Cancer 136 : 359-386.
2. Sogukpınar N, Saydam BK, Can HO, Hadımlı A, Bozkurt OD, et al. 21. Huchko MJ, Bukusi EA, Cohen CR (2011) Building capacity for cervical
(2013) Assessment of cervical cancer risk in women between 15 and 49 cancer screening in outpatient HIV clinics in the Nyanza province of
years of age: case of Izmir. Asian Pac J Cancer 14: 2119-2125. western Kenya. Int J Gyne Obstet 114: 106-110.
3. Papri FS, Khanam Z, Islam F, Hakim MM (2015) Knowledge and 22. Shakya S, Karmacharya BM, Afset JE, Bofin A, Åsvold BO, et al. (2016)
awareness about risk factors of cervical cancer, its screening and Community-based health education has positive influence on the attitude
vaccination among the women attending Chittagong Medical College to cervical cancer screening among women in Rural Nepal. J Cancer Edu
Hospital. Chattagram Maa-O-Shishu Hospital Med College J 14: 57-60. 31: 547-553.
4. Hussain SA, Sullivan R (2013) Cancer control in Bangladesh. Jpn J Clin 23. Rosser JI, Njoroge B, Huchko MJ (2015) Knowledge about cervical cancer
Oncol 43:1159-1169. screening and perception of risk among women attending outpatient
clinics in rural Kenya. Int J Gyne Obstet 128: 211-215.
5. Sharmin T, Parvin S, Islam MA, Islam MM, Das SK, et al. (2014) Current
status and prospective of cancer disease in Bangladesh: A cross-sectional 24. Fylan F (1998) Screening for cervical cancer: A review of women's
survey. IOSR J Pharmacy 4 : 41-47. attitudes, knowledge, and behaviour. Br J Gen Pract 48: 1509-1514.
6. Ochomo EO, Atieli H, Gumo S, Ouma C (2017) Assessment of 25. Bosch FX, Munoz N, De Sanjosé S, Izarzugaza I, Gili M, et al. (1992) Risk
community health volunteers knowledge on cervical cancer in Kadibo factors for cervical cancer in Colombia and Spain. Int J Cancer
Division, Kisumu County: A cross sectional survey. BMC Health Services 52:750-758.
Res 17: 675. 26. William M, Kuffour G, Ekuadzi E, Yeboah M, ElDuah M, et al. (2013)
7. Franceschi S, Rajkumar T, Vaccarella S, Gajalakshmi V, Sharmila A, et al. Assessment of psychological barriers to cervical cancer screening among
(2003) Human papillomavirus and risk factors for cervical cancer in women in Kumasi, Ghana using a mixed methods approach. Afr Health
Chennai, India: A casecontrol study. Int J Cancer 107: 127-133. Sci 13: 1054-1061.
8. Bathija GV, Mallesh S, Gajula M (2016) A study on awareness of cervical
cancer among women of reproductive age group in urban slums of old

J Carcinog Mutagen, an open access journal Volume 10 • Issue 4 • 1000341

ISSN: 2157-2518
Citation: Haque NB, Shahi A, Islam T, Baki MO (2019) Assessment of Knowledge on Cervical Cancer among Bangladeshi Women: A Hospital
Based Cross Sectional Study . J Carcinog Mutagen 10: 341.

Page 6 of 6

27. Mutyaba T, Mmiro FA, Weiderpass E (2006) Knowledge, attitudes and students at a medical school in Al-Ahsa, Kingdom of Saudi Arabia. Asian
practices on cervical cancer screening among the medical workers of Pac J Cancer Prev 15: 2529-2532.
Mulago Hospital, Uganda. BMC Med Edu 6: 13. 34. Lim JN, Ojo AA (2017) Barriers to utilisation of cervical cancer screening
28. Marlow LA, Waller J, Wardle J (2007) Public awareness that HPV is a risk in Sub Sahara Africa: A systematic review. Euro J Cancer Care 26: 12444.
factor for cervical cancer. Br J Cancer 97: 691. 35. Daley E, Perrin K, Vamos C, Hernandez N, Anstey E, et al. (2013)
29. Raychaudhuri S, Mandal S (2012) Socio-demographic and behavioural Confusion about Pap smears: Lack of knowledge among high-risk
risk factors for cervical cancer and knowledge, attitude and practice in women. J women's Health 22: 67-74.
rural and urban areas of North Bengal, India. Asian Pac J Cancer Prev 36. Wongwatcharanukul L, Promthet S, Bradshaw P, Jirapornkul C,
13 : 1093-1096. Tungsrithong N (2014) Factors affecting cervical cancer screening uptake
30. Daley E, Perrin K, Vamos C, Hernandez N, Anstey E, et al. (2013) by Hmong hilltribe women in Thailand. Asian Pac J Cancer Prev 15:
Confusion about Pap smears: Lack of knowledge among high-risk 3753-3756.
women. J Women's Health 22: 67-74. 37. Mohanty G, Ghosh SN (2015) Risk factors for cancer of cervix, status of
31. Rosser JI, Zakaras JM, Hamisi S, Huchko MJ (2014) Men’s knowledge and screening and methods for its detection. Arch Gynecol Obst 291:
attitudes about cervical cancer screening in Kenya. BMC Women's 247-249.
Health. 14: 138. 38. Maree JE, Kaila I (2014) Zambian women’s experiences and
32. Yoruk S, Açıkgoz A, Ergor G (2016) Determination of knowledge levels, understanding of cervical cancer: A qualitative study. Int J Gynecological
attitude and behaviors of female university students concerning cervical Cancer 24:1065-1071.
cancer, human papiloma virus and its vaccine. BMC Women's Health 16: 39. Simayi D, Yang L, Li F, Wang YH, Amanguli A, et al. (2013)
51. Implementing a cervical cancer awareness program in low-income
33. Mulhim NK, Saad Morsi AM (2014) Knowledge about cervical cancer settings in Western China: A community-based locally affordable
early warning signs and symptoms, risk factors and vaccination among intervention for risk reduction. Asian Pac J Cancer Prev 14:7459-7466.

J Carcinog Mutagen, an open access journal Volume 10 • Issue 4 • 1000341

ISSN: 2157-2518