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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DESSERTATION
MS. JASMINE PHILIP
1
2
NAME OF THE
CANDIDATE AND
ADDRESS
NAME OF THE
INSTITUITION
3
COURSE OF STUDY
AND SUBJECT
4
DATE OF
ADMISSION TO
COURSE
1ST YEAR MSc NURSING,
RAJIV GANDHI COLLEGE OF NURSING,
IIT CAMPUS,
OPP. MEENAKSHI TEMPLE,
BANNERGHATTA ROAD,
BANGALORE – 76.
RAJIV GANDHI COLLEGE OF NURSING
IST YEAR MSC NURSING
OBSTRETICS AND GYNAECOLOGICAL NURSING.
10/10/2010
A STUDY TO ASSESS THE EFFECTIVENESS OF
TITLE OF THE
5
TOPIC
STRUCTURED
PREVENTION
TEACHING
AND
PROGRAMME
TREATMENT
OF
ON
CERVICAL
CANCER AMONG WOMEN IN A SELECTED URBAN
COMMUNITY AT BENGALURU.
BRIEF RESUME OF INTENTED WORK
6.1 INTRODUCTION
“Happiness is not something you postpone for the future; it is something you design for the
present”.
JimRohn
Womanhood is the period in a female's life after she has transitioned through childhood and
adolescence, generally age 18. Puberty generally begins at about age 10, followed by menarche at age 12
to 13.Women play an essential role in maintaining family and community health. Over the past hundred
years, despite this changing view of the role of women in the family, and not discounting men's
contributions to childcare and household chores, women still maintain the primary responsibility for care
of the children and household.1 Woman’s health problems that require specific attention and specific
treatment and action. Some woman’s health problems will require a bit more effort than others, but
virtually all can be eliminated if proper natural health steps are taken to eliminate the causes.2
Cancer is one of the frequently talked about and most feared diseases that falls under the genre of
lifestyle diseases that have evolved, rather rapidly, in the past two decades. Cancer is a generic term for a
large group of diseases that can affect any part of the body. Other terms used are malignant tumors and
neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their
usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. This
process is referred to as metastasis. Metastases are the major cause of death from cancer.12
Carcinoma of the cervix is the most common cancer among women in India and leading cause of
cancer death worldwide. In India annually 16% of the world total cases occur and only 5% of these are
reported in early stages hence reducing the burden of cancer cervix remains an important health goal.5
There are two types of cells on the cervix's surface: squamous and columnar. Most cervical cancers are
from squamous cells. Cervical cancer usually develops very slowly. It starts as a precancerous condition
called dysplasia. This precancerous condition can be detected by a Pap smear and is 100% treatable. That
is why it is so important for women to get regular Pap smears. Most women who are diagnosed with
cervical cancer today have not had regular Pap smears or they have not followed up on abnormal Pap
smear results.13
Cancer of the cervix is the second most common cancer in women worldwide and is a leading cause of
cancer-related death in women in underdeveloped countries. Worldwide, approximately 500,000 cases of
cervical cancer are diagnosed each year. Routine screening has decreased the incidence of invasive
cervical cancer in the United States, where approximately 13,000 cases of invasive cervical cancer and
50,000 cases of cervical carcinoma in situ (i.e., localized cancer) are diagnosed yearly. Cervical
cancer claims almost half a million women worldwide. In 99.7% of all affected women, it results from a
history of persistent infection by a family of more than 100-related viruses called human papillomavirus
(HPV). As many as 80% of all sexually-active women have a risk of infection. 14
A study was conducted by P.Bhattacharya in 2007 to examine whether predisposition to human
papillomavirus (HPV) 16/18-related cervical cancer (CaCx) because of p53 proline homozygosity
(Pro72Pro) among Indian women was mediated singly or jointly with immunogenetic risk factors at
Kolkata. Modulation of p53Pro72Pro-mediated susceptibility to CaCx by immunogenetic factors could
possibly be mediated through cross talk between HPV16/18-induced immune evasion and cell
transformation.16
The role of cytology in prevention and early detection of cervical cancer is unequivocally proven and
Pap smear is considered as the gold standard in cervical cancer screening. Pap smear fulfills the criteria
for ideal screening test. It is cost effective acceptable and adoptable for population based screening. It is
sensitive enough to detect preinvasive disease resulting in decreasing mortality and morbidity due to
cervical cancer.3
A study conducted on December 2005 by R.Dabash on strategic assessment of cervical cancer
prevention and treatment services in 3 districts of Uttar Pradesh, India. The assessment included a review
of the available literature, observations of services, collection of hospital statistics and the conduct of
qualitative research (in-depth interviews and focus group discussions) to assess the perspectives of
women, providers, policy makers and community members. There were gaps in provider knowledge and
practices, potentially attributable to limited provider training and professional development opportunities.
In the absence of a state policy on cervical cancer, screening of asymptomatic women was practically
absent, except in the military sector. Cytology-based cancer screening tests (i.e. pap smears) were often
used to help diagnose women with symptoms of reproductive tract infections but not routinely screen
asymptomatic women. Access to appropriate treatment of precancerous lesions was limited and often
inappropriately managed by hysterectomy in many urban centers. Cancer treatment facilities were well
equipped but mostly inaccessible for women in need. Finally, policy makers, community members and
clients were mostly unaware about cervical cancer and its preventable nature, although with information,
expressed a strong interest in having services available to women in their communities.9
The role of sexually transmitted agents in the etiology of cervical cancer has been suspected for more
than a century, but knowledge in this field has rapidly expanded only in the last 20 years, after major
improvements were made in detection methods for human papillomavirus. Therefore, early detection and
treatment of cervical cancer may prevent later development of complications.16
NEED FOR THE STUDY
All human life on this planet is born of woman. Woman is an important person in the family. She
nourishes her fetus and gives birth to child. Health of mother is tender and wanted component of total
care and cannot be neglected because of the fact that if mother is healthy, the children will be healthy
which in turn affect nation’s health. So mental, physical and physiological health affect the health of the
family and the nation. Most women who die from cervical cancer, particularly in developing countries,
are in the prime of their life.2
Cancer of the cervix occurs when the cells of the cervix change in a way that leads
to abnormal growth and invasion of other tissues or organs of the body. The slow progression through
numerous precancerous changes is very important because it provides opportunities for prevention and
early detection and treatment. These opportunities have caused the decline of cervical cancer over the past
decades in the United States.6
There were an estimated 530 000 cases of cervical cancer and 275 000 deaths from the
disease in 2008. Cervical cancer is the leading cause of cancer-related death among women in Eastern,
Western and Middle Africa; Central America; South-Central Asia and Melanesia. The highest incidence
rate is observed in Guinea, with ∼6.5% of women developing cervical cancer before the age of 75 years.
India is the country with the highest disease frequency with 134000
cases and 73 000 deaths. 8 The
incidence of cervical cancer in Delhi, at 26.6 per hundred thousand women of any age group tops the
numbers due to any other women's cancer. The age distribution of cervical cancer is pyramidal with a
higher percentage of younger women being diagnosed with precancer symptoms and invasive disease.7
There are many causes of cervical cancer but some of the important are Human Papilloma
Virus (HPV): Human Papilloma Viruses is a group of viruses that causes warts, cancerous and noncancerous tumors. HPV can infect to the reproductive tract, external genital and closer part of anus. HPV
can transfer from one person to other through sexual relationship.15
Often during the early stages people may experience no symptoms at all. That is why women
should have regular cervical smear tests. The most common symptoms are bleeding between periods,
Bleeding after sexual intercourse, Bleeding in post-menopausal women, Discomfort during sexual
intercourse, Smelly vaginal discharge, Vaginal discharge tinged with blood, Pelvic pain.17
Cervical cancer is the easiest female cancer to prevent, with regular screening tests and followup. Two screening tests can help prevent cervical cancer or find it early, the Pap test (or Pap smear) looks
for precancers, cell changes on the cervix that might become cervical cancer if they are not treated
appropriately, the HPV test looks for the virus (human papillomavirus) that can cause these cell
changes.14
Treatment for early stage cervical cancer - cancer that is confined to the cervix - has a
success rate of 85% to 90%. Early stage cancer treatment like surgery is commonly used when the cancer
is confined to the cervix. Radiotherapy may be used after surgery if the doctor believes there may still be
cancer cells inside the body. The options for surgery in the early stages may include Cone biopsy
(conization), Laser surgery, LEEP (loop electrosurgical excision procedure) Cryosurgery, Hysterectomy.
In the later stages of cancer palliative therapy is administered to relieve symptoms and improve quality of
life.18The number of sexual partners seems to be a surrogate for HPV infections, and the risk of cervical
cancer may be directly related to the number of pregnancies and births. The risk persisted even after
adjusting for sexual and socio economic factors.11
A case control study was conducted on October 2003 to evaluate the role of human
papillomavirus (HPV) and other risk factors in the etiology of invasive cervical carcinoma (ICC), in
Chennai, Southern India with 205 cases (including 12 adenocarcinomas) and 213 frequency age-matched
control women were included. Incidence rates in the country, however, varied between 11 per 100,000 in
Trivandrum and 30 per 100,000 in Chennais, all in Southern India.10
Cervical cancer can have serious adverse effects on the women. It is the most common
type of cancer among women which can be prevented and treated. There is lack of awareness among
women on cervical cancer, its early detection, prevention and treatment. If knowledge is given about
cervical cancer prevention and treatment to different groups, it will help in promoting health. Thus the
investigator felt to conduct a study on prevention and treatment of cervical cancer.
6.3 REVIEW OF LITERATURE:The reviews of literature are arranged under following headings:1. General descriptions on cervical cancer.
2. Review related to cervical cancer.
3. Review related to knowledge regarding cervical cancer.
4. Review related effectiveness of teaching programme.
1. General descriptions on cervical cancer
Cancer of the cervix is the third most common reproductive cancer. The accessible location of the
cervix to both cell and tissue study direct examination have led to both cell and tissue study and direct
study examination have led to both a refinement of diagnostic techniques, contributing to improved
management disorders. The incidence of invasive cancer has decreased by 50% over the last 30 years,
reducing mortality rates.
Cancer of the cervix begins as neoplastic changes in the cervical epithelium. Terms that have been
used to describe these epithelial changes or preinvasive lesions include dysplasia and cervical
intraepithelial neoplasia (CIN). The average age range for the occurrence of cervical cancer is 40 -50
years; however, preinvasive conditions may exist for 10 – 15 years before the development of an invasive
carcinoma. About 90% of cervical cancers are caused by human papillomavirus. A strong link has been
established between HPV types 16 and 18 and cervical neoplasia. Eighteen other types have been
associated with genital tract infections and also may be associated with CIN. Other sexually transmitted
infections that are identified as risk factors are herpes simplex virus II and possibly cytomegalovirus.
Other risk factors include early age at first coitus; multiple sexual partners; a sexual partner with a history
of multiple sexual partners; and belonging to a lower socioeconomic group. Other potential factors
include use of contraceptives, cigarette smoking, and intrauterine exposure to diethylstilbestrol. Vitamins
A,C,E, and folate may be protective.
Preinvasive cancer of the cervix is often asymptomatic. Abnormal bleeding, especially postcoital
bleeding, is the classic symptom of invasive cancer. Other late symptoms include rectal bleeding,
hematuria, back pain, leg pain and anemia. Diagnosis includes taking history that includes menstrual and
sexual activity information, particularly a history of sexually transmitted infections and abnormal
bleeding episodes. A pelvic examination usually will be normal except in late-stage cancer.
The single most reliable method to detect preinvasive cancer is the Pap test. The Pap test will detect
90% of early cervical changes. HPV testing has been suggested as an alternative to methods of follow up
for abnormal Pap results. A consensus conference sponsored by the American Society for Colposcopy
and Cervical Pathology published guidelines for management of women with cervical cytology
abnormalities. Repeated Pap testing, colposcopy, and DNA HPV tests are all safe and effective.
Once a diagnosis has been identified, a course of treatment is planned. For preinvasive lesions,
several techniques are used. The techniques currently available for preinvasive lesions are cryotherapy,
laser therapy, and LEEP. These three techniques have comparable success rates in treating CIN
successfully. Treatment for invasive cancer includes surgery, radiation therapy, and chemotherapy.4
2. Review related to cervical cancer.
A study was conducted by P.E.Gravitt on 2010 on effectiveness of VIA, and HPV DNA testing in a
cervical cancer screening program in a peri urban community in Andhra Pradesh. Sensitivity, specificity,
positive and negative predictive values were adjusted for verification bias. HPV testing had a higher
sensitivity (100%) and specificity (90.6%) compared to Pap cytology Since 58% of the sample refused
involvement and another 28% refused colposcopy or biopsy, we estimated that potentially 87.6% of the
total underlying cases of CIN3 and cancer may have been missed due to program failures.24
A study conducted by R.Murilla on 2009 October on HPV prevalence in Colombian women
with cervical cancer shows human Papillomavirus (HPV) vaccines have been considered potentially costeffective for the reduction of cervical cancer burden in developing countries; their effectiveness in a
public health setting continues to be researched. HPV-16/18 prevalence was 63.1%. Multiple high-risk
infections appeared in 16.6% of cases and represent a chance of replacement. Age-specific HPV
prevalence and multiple high-risk infections might influence vaccine impact. Both factors highlight the
role of HPVs other than 16/18, which should be considered in cost-effectiveness analyses for potential
vaccine impact.19
A study conducted by R.Sankaranarayanan on 2008 august cervical cancer prevention and
human papillomavirus infection in India, Bangladesh, Sri Lanka and Nepal. Prevalence of human
papillomavirus (HPV) infection among the general populations varies from 7-14% and the age-specific
prevalence across age groups is constant with no clear peak in young women. High-risk HPV types were
found in 97% of cervical cancers, and HPV-16 and 18 were found in 80% of cancers in India. Cytology,
HPV testing and visual screening with acetic acid (VIA) or Lugol's iodine (VILI) are known to be
accurate and effective methods to detect cervical cancer and could contribute to the reduction of disease
in these countries. While HPV vaccination provides hope for the future, several barriers prohibit the
introduction of prophylactic vaccines in these countries such as high costs and low public awareness of
cervical cancer. Efforts to implement screening based on the research experiences in the region offer the
only currently viable means of rapidly reducing the heavy burden of disease.22
A study conducted in Tamil Nadu by C.K.Gajalakshmi on 1996 about cervical cancer
screening. The present study was undertaken to examine if the village health nurse (VHN) could be
trained quickly to identify a cervical abnormality by visual inspection so that we could 'down stage' the
cancer to earlier stages, more amenable to treatment. VHNs also would be trained to take an adequate Pap
smear. A total of 101 VHNs were trained in batches and returned to their villages. Within two years,
6,459 engible women in the study area were screened. The agreement between the gynecologists and the
VHNs in identifying cancer among those with abnormal cervix was 95 percent, and 80 percent of the Pap
smears taken by VHNs were adequate by WHO criteria, making the feasibility study highly successful.21
Epidemiologic studies conducted by F.X.Bosch on 1995 have shown that the association of
genital human papillomavirus (HPV) with cervical cancer is strong, independent of other risk factors, and
consistent in several countries. There was significant geographic variation in the prevalence of some less
common virus types. A clustering of HPV 45 was apparent in western Africa, while HPV 39 and HPV 59
were almost entirely confined to Central and South America. In squamous cell tumors, HPV 16
predominated (51% of such specimens), but HPV 18 predominated in adenocarcinomas (56% of such
tumors) and adenosquamous tumors (39% of such tumors).20
A study conducted by A.K.Prabhakar on 1992 on cervical cancer in India – strategy control
available information on the incidence of cancers by site in India have indicated that of incidence of
cancer of uterine cervix among women is by far the highest compared to other sites in women. The
epidemiology of cervical cancer has been studied extensively in India and in other countries. The majority
of factors related to cervical cancer are associated with sexual behavior.23
3. Review related to knowledge regarding cervical cancer.
A study conducted by A.Uysal on 2008 to examine knowledge about cervical cancer and in
relation to Papanicolaou (Pap) testing among Turkish women. This cross-sectional study research was
carried out at Ege University Faculty of Medicine Hospital's Obstetric and Gynecology Outpatient Clinic
between March 1st, and May 30th, 2008 with 92 volunteer women who were sexually active and aged 25
to 61. The knowledge of the women within the scope of the research concerning cervical cancer risk
factors (having a sexually transmitted disease, giving birth to many children, smoking, having sexual
activity with a man who has had partners with a cervical cancer and having sexual intercourse at an early
age) was found to be related with their condition of having pap testing.27
A study conducted in Uganda by T.Mutyaba on 2006 march about the knowledge, attitudes
and practices on cervical cancer screening among the medical workers, response rate was 92% (285). Of
these, 93% considered cancer of the cervix a public health problem and knowledge about Pap smear was
83% among respondents. Less than 40% knew risk factors for cervical cancer, eligibility for and
screening interval. Of the female respondents, 65% didn't feel susceptible to cervical cancer and 81% had
never been screened. Of the male respondents, only 26% had partners who had ever been screened. Only
14% of the final year medical students felt skilled enough to use a vaginal speculum and 87% had never
performed a pap smear.26
The descriptive exploratory type of study was carried out by Mina Shrestha on 2006
February to explore the knowledge of cervical cancer prevention and screening among married women
attending in Gyane OPD in Lumbini Zonal Hospital, Butwal. Major findings drawn from this study shows
that most of the respondents 45(90%) had heard of cervical cancer screening. Most of the respondents35
(77.77%) had answered cervical cancer can be early detected and main sources of information regarding
cervical cancer had been relatives/friends and media (67% and 33%). Most of the respondents
22(48.88%) answered predisposing factor of cervical cancer is suffered from STI(HIV/HPV) and multiple
sexual partner.35(77.77%) respondents felt necessary to prevent cervical cancer,34(68%) respondents
were not doing cervical cancer screening because of don' t have problem. The women who were included
in the study had inadequate knowledge regarding cervical cancer screening and prevention.25
4. Review related effectiveness of teaching programme.
A Quasi Experimental Study conducted by Suja Kumari S in 2007 to Evaluate the Effectiveness of
Structured Teaching Programme on Pap smear Among Women in a Selected Rural Community,
Bangalore.” Results shown the effectiveness of the STP and a significant difference 28.72 (P<0.05) was
found between pre-test and post-test knowledge scores of respondents indicating significant increase in
knowledge after STP. Hence, hypothesis is accepted and STP was found to be effective in improving the
knowledge of women.28
A study was conducted by Eleazar Christina in 2007 on effectiveness of planned teaching
programme on prevention and early detection of cervical cancer for school teachers of selected schools in
Mangalore. Findings of the study showed that the knowledge scores of school teachers were not adequate
before the introduction of planned teaching programme. The PTP facilitated them to learn about
prevention and early detection of cervical cancer, which was evident in post- test knowledge scores. Posttest measures showed significant increase in the knowledge scores of school teachers. Hence planned
teaching programme was an effective teaching method for providing the knowledge of school teachers,
which was well-appreciated and accepted by them.29
A study was conducted by Selvi M on 2005 to evaluate the effectiveness of Health – education
programme on cervical cancer residing at kadalu village, Hassan”. Results revealed the mean percentage
of knowledge score of assessment variable was only 13.98. And majority of the women had inadequate
knowledge regarding cancer cervix. The mean post – test knowledge score higher than the mean pre – test
knowledge score. So the Health – education programme was found to be a much effective method in
terms of creating awareness regarding risk factors, signs and symptoms early detection and prevention of
cervical cancer.30
6.4 STATEMENT OF THE PROBLEM:A study to assess the effectiveness of structured teaching programme on cervical cancer among
women in a selected urban community at Bengaluru.
6.5 OBJECTIVES OF THE STUDY: To assess the knowledge of women regarding prevention and treatment of cervical cancer before
structured teaching programme.
 To assess the effectiveness of structured teaching programme on prevention and treatment of
cervical cancer.
 To find association between level of knowledge on prevention and treatment of cervical cancer
among women with selected demographic variables.
6.6 OPERATIONAL DEFINITION:-
1. Assess:
It refers to determine the existing knowledge of women regarding prevention and treatment of cervical
cancer.
2. Effectiveness:
It refers to determine whether the structured teaching programme regarding prevention and treatment
of cervical cancer has achieved the desired gain in pre-test and post-test knowledge score.
3. Structured Teaching Programme:
It is a teaching programme prepared by the investigator on cervical cancer, etiology, clinical
manifestation, its prevention and treatment with the use of A.V. Aids to enhance women awareness
about cervical cancer and its prevention and treatment.
4. Prevention and Treatment:
It is a measure taken to reduce the incidence and to limit the progression of cervical cancer and
provide intervention regarding cervical cancer.
5. Cervical Cancer:
It is malignant neoplasm of the cervix uteri or cervical area.
6. Women:
In this study it refers to the women under the age group between 15 – 45 years.
: 6.7 ASSUMPTIONS:1. Women have less knowledge regarding cervical cancer.
2. Structured teaching programme will enhance the knowledge level of women.
3. The knowledge level of women will be different.
6.8 HYPOTHESIS:H1: There is a significant association between knowledge on prevention and treatment of cervical
cancer and selected demographic variables.
6.9 DELIMITATION:This study is limited to women in a selected urban community.
7. MATERIALS AND METHOD:7.1 SOURCE OF DATA:Data will be collected from women in reproductive age group between 15-45 years in a selected
urban community Bengaluru.
7.1.1 RESEARCH DESIGN:One group pre test- post test experimental research design.
7.1.2 SETTINGS:The study will be conducted in selected urban community in Bengaluru.
7.1.3 POPULATION:The target population of the study consists of women from selected urban community in
Bengaluru.
7.2 METHOD OF DATA COLLECTION:7.2.1 SAMPLING PROCEDURE:Convenience sampling technique.
7.2.2 SAMPLE SIZE:The sample consisted of 60 women from a selected urban community.
7.2.3 INCLUSION CRITERIA: All the women in reproductive age group between 15 – 45years.
 Women who are willing to participate in the study.
 Women who can read and write English and Kannada.
 Women residing in urban areas at Bengaluru.
7.2.4 EXCLUSION CRITERIA: Women who are illiterate.
 Women already exposed to health education programme on cervical cancer.
 Women who are health care professional.
7.2.5 INSTRUMENTS INTENDED TO BE USED:Instrument consists of two parts;
PART-1: Socio Demographic Variables.
PART-2: Structured Knowledge Questionnaire.
PART-3: Structured Teaching Programme on Cervical Cancer.
7.2.6 DATA COLLECTION METHOD:Data will be collected from women before and after structured teaching programme by using
knowledge questionnaire.
7.2.7 PLAN FOR DATA ANALYSIS:1. Differential: Mean, mode, median standard deviation, percentage will be calculated.
2. Inferential: chi square and T test will be done to evaluate the effectiveness of STP.
7.3 DOES THE STUDY REQUIRE INVESTIGATION OR INTERVENTION TO BE
CONDUCTED ON PATIIENT OR OTHER HUMAN OR ANIMAL?
Yes, the study will be conducted among the women from a selected urban community, on
prevention and treatment of cervical cancer.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION:Yes, prior written permission order has been obtained from the primary health center of selected
area before conduct of study. A written consent also will be obtained from the women.
REFERENCES
1. Reeder.S.J, Martin LL and Koniak.D. :( 1992); Maternity Nursing; 17th edition; Philadelphia
Lippincott co.
2. Kutti ; Journal of obstetrics and gynecology.(2006);354-357.
3. Comprehensive cervical cancer control: a guide to essential practice. World Health
Organization , Reproductive Health and Research, World Health Organization. Chronic
Disease and Health Promotion-2006, page.3.
4.
Lowedermilk, Perry, Bobak;(1997); Maternity and Women’s Helth Care; Mosby Publishes;
6th
edition;
5. Emily, Jean, Sheron et.al; Maternal Child Nursing; (2001); Sunders Company;
6. Dickason, Schult & Silverman (1990). Maternal – Infant Nursing Care; Mosby Publishers;
7. Hansjorj Senn , Rudolf Morant. Tumor prevention and Genetics 3. Page.277
8. Padmini Murthy, Clyde Lanford Smith. Women’s Global Health and Human Rights.
Cervical cancer: Prevention and Screening Strtegies. Page. 269.
9. Rasha Dabash, Jyoti Vajpayee et.al, strategic assessments of cervical cancer prevention and
treatment services , dec 2005.
10. Arbyn M, et al. Worldwide burden of cervical cancer in 2008. 2010 April,6.
annoc.oxfordjournals.org/PMID:21471563.
11. Alberto Manetta. Cancer prevention and early diagnosis in women. Risk factors. Page.151.
12. www.indianwomen.org
13. www.naturalhealthinformastioncentre.com
14. www.medicinenet.com
15. www.vaxa.com
16. www.medindia.net
17. Articles.timesofindia.indiatimes.com
18. Cervical cancer. http// www.wikipedia,encyclopedia/wks/cervicalcancer.
19. R.Murillo, et al. HPV Prevalence in Colombian women with cervical cancer.
www.hindawi.com/journals/idog.
20. F.X.Bosch,
et
al.
Prevalence
of
human
papillomavirus
in
cervical
cancer.
Jnci.oxfordjournals.org.
21. C.K.Gajalakshmi, et al. Cervical cancer in Tamil Nadu.,1996, International Agency for
Research on Cancer,IARC. www.jstor.org/stable.
22. R.Sankaranarayanan, et al.Human papillomavirus infection and cervical cancer prevention
in India, Bangladesh, Sri Lanka and Nepal. vaccine2008,aug19:20..
23. A.K.Prabhakar, et al. Cervical cancer in India- strategy control.,1992. Indian Council of
Medical Research,.
24. P.E.Gravitt, et al. Effectiveness of VIA and HPV DNA testing in cervical cancer screening
program in a peri urban community in A.P.
25. Mina Shrestha, et al. Knowledge regarding Prevention of Cervical Cancer among married
women attending in Gynaec OPD in Lumbia Zonal Hospital, Butwal. Population reference
bureau, PATH. http://www.path.org/files/RHprp-accp cervical cancer worldw.pdf.
26. T.Mutyaba, et al. Knowledge, attitudes and practices on cervical cancer screening among the
medical workers. 2006 March, 1.
27. A.Uysal, et al. Knowledge about cervical cancer risk factors and PAP testing behavior.
28. Suja Kumari S. A quarsi experimental study to evaluate the effectiveness of STP on Pap
smear among women in a selected rural community. Bangalore. Nov2007.
29. Eleazar Christina. Effectiveness of planned teaching programme on prevention and early
detection of cervical cancer for school teachers of selected schools in Mangalore.2007.
30. Selvi M. A study to evaluate the effectiveness of health education programme on cervical
cancer among married women residing at Kadalu village, Hassan. Dec 2005.
1.
Signature of Candidate
2.
Remarks of the Guide
CAN PROCEED.CAN BE USEFUL AND
INFORMATIVE FOR THE WOMEN.
3. Name and Designation of the MRS.S.P.VASUMATHI
Guide
4. Signature
5. Head of the department
MRS.S.P.VASUMATHI
6. Signature
7. Remarks
of
chairman
principal
8. Signature of Principal
THE STUDY IS FEASIBLE TO CONDUCT
and AMONG WOMEN.