Knowledge of risk factors for gynecological cancers among medical and pharmacy students at the university of Lomé, Togo: a prospective cross-sectional study from 1 to 31 September 2021.

Of the 936 eligible students, 640 participated, yielding a 68.4% participation rate. The average age was 24.6 years with a standard deviation of 2.7 years and extremes of 19 and 32 years. The age group [25–30[ years represented 51.6% of the total workforce (table 1 ). The sample consisted of 456 men (71.3%). The male-to-female ratio was 2.5:1. Doctoral students represented 63.3% of respondents ( n  = 405), followed by undergraduate students (18.9%) and masters students (17.8%). Medical students comprised 92.3% ( n  = 591) and pharmacy students 7.7% ( n  = 49). Out of 640 respondents, 588 or 91.9% completed an internship in the gynecology department. Of the 640 respondents, 81.9%; 88.9%; 67.7%; 26.4% and 12.7% had received education on cancer of the ovaries, cervix, endometrium, vagina and vulva respectively (table 2 ). Table 1 Distribution of students by age group Number % [15–20[ 5 0.8 [20–25[ 281 43.9 [25–30[ 330 51.6 [30–35[ 24 3.8 Total 640 100.0 Distribution of students by age group Table 2 Distribution of students according to the teaching of the different gynecological cancers Ovary Cervix Endometrium Vagina Vulva n % n % n % n % n % Already followed an education 640 100 640 100 640 100 640 100 640 100  Yes 524 81.9 569 88.9 433 67.7 169 26.4 81 12.7  No 116 18.1 71 11.1 207 32.3 471 73.6 559 87.3 Information channel 524 100 569 100 433 100 169 100 81 100  Courses at the faculty 511 97.5 542 95.3 411 94.9 127 75.1 64 79.0  Personal research 117 22.3 161 28.3 91 21.0 65 38.5 31 38.3  Awareness 42 8.0 110 19.3 24 5.5 18 10.7 8 9.9  Television/Radio 37 7.1 123 21.6 30 6.9 17 10.1 7 8.6  Friends 16 3.1 37 6.5 16 3.7 4 2.4 3 3.7  Family 3 0.6 15 2.6 2 0.5 0 0.0 0 0.0 n = number; %: estimated percentage proportion Distribution of students according to the teaching of the different gynecological cancers n = number; %: estimated percentage proportion Table 3 Distribution of students by knowledge of risk factors for cervical cancer n  = 362* % Multiple sexual partners 198 54.7 HPV 193 53.3 Smoking 87 24.0 Early first sexual intercourse 63 17.4 Multiparity 61 16.9 low socio-economic level 39 10.8 Sexually transmitted infections 29 8.0 Unprotected sex 16 4.4 HIV 14 3.9 Family history 14 3.9 No vaccination against HPV 14 3.9 Lower genital infection 8 2.2 Immunodepression 5 1.4 Poorly treated cervicitis 3 0.8 Benign cervical lesions 2 0.6 HSV-2 infection’s 1 0.3 Exposure to diethylstilbestrol 1 0.3 Illiterate 1 0.3 HPV: Human Papilloma Virus; HIV: Human Immunodeficiency Virus; HSV: Herpes Simplex Virus *= Number of students aware of cervical cancer risk factors Distribution of students by knowledge of risk factors for cervical cancer HPV: Human Papilloma Virus; HIV: Human Immunodeficiency Virus; HSV: Herpes Simplex Virus *= Number of students aware of cervical cancer risk factors Student knowledge of cervical cancer risk factors varied. Out of 640 students, 545 respondents or 85.2% said that there are risk factors of cervical cancer. Among them, 66.4% ( n  = 362) knew the risk factors of the cervical cancer. The most commonly cited risk factors were multiple sexual partners (54.7%), HPV infection (53.3%), and smoking (24.0%) (table 3 ). There is a statistically significant association between knowledge of risk factors of cervical cancer and student age ( p -value = 0.0002), female sex ( p -value = 0.0001; ORa = 2.46; 95 CI % [1.31–3.36]) and the fact of having followed a course on cervical cancer ( p -value = 0.0073; RCa = 1.68; 95% CI [1.25–32.08]). (table 4 ) Table 4 Factors associated with knowledge of risk factors for cervical cancer Univariate analysis Multivariate analysis n / N % OR CI 95% p -value ORa CI 95% p -value Age (years) 0.0001 0.0002  [15–20[ 2/3 66.7 1.00 - 1.00 -  [20–25[ 130/205 63.4 1.42 1.12–2.76 1.33 1.02–2.35  [25–30[ 212/313 67.7 1.78 1.38–2.95 1.84 1.44–2.71  [30–35[ 18/24 75.0 2.37 1.44–3.08 2.61 1.72–4.21 Gender 0.00005 0.0025  Male 240/386 62.2 1.00 - 1.00 -  Female 122/159 76.7 2.33 1.15–4.27 2.46 1.31–3.36 Study cycle  Bachelor 40/62 64.5 1.00 - 0.782  Master 51/93 54.8 0.73 0.25–1.56  Doctorate 271/390 69.5 1.74 0.84–3.22 Internship in G-O 1.78  No 27/38 71.1 1.00 -  Yes 335/507 66.1 0.67 0.55–1.81 Followed an education 0.0002 0.0073  No 8/20 40.0 1.00 - 1.00 -  Yes 354/525 67.4 1.84 1.41–2.42 1.68 1.25–2.08 N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Factors associated with knowledge of risk factors for cervical cancer N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Table 5 Distribution of students according to knowledge of risk factors for endometrial cancer n  = 186* % Family history of endometrial cancer 57 30.6 Smoking 40 21.5 Late menopause 37 19.9 Obesity 34 18.3 Genetic factor 30 16.1 Hormonal facteur 27 14.5 Age 26 14.0 Early puberty 25 13.4 Endometriosis 17 9.1 Race 16 9.1 Diabete 14 7.5 Oral contraceptives 12 6.5 Hyperoestrogenism 9 4.8 Lynch syndrome 8 4.3 Hormone replacement therapy 5 2.7 Tamoxifen 5 2.7 Microplastic ovaries 3 1.6 Nullity 2 1.1 *= Number of students aware of endometrial cancer risk factors Distribution of students according to knowledge of risk factors for endometrial cancer *= Number of students aware of endometrial cancer risk factors Table 6 Factors associated with knowledge of risk factors for endometrial cancer Univariate analysis Multivariate analysis n / N % OR CI 95% p -value ORa CI 95% p -value Age (years) 1.036  [15–20[ 0/0 0.0 1.00 -  [20–25[ 56/125 44.8 1.29 0.68–1.78  [25–30[ 121/255 47.5 2.45 1.22–2.97  [30–35[ 9/17 52.9 2.52 1.12–3.81 Gender 0.298  Male 131/302 43.4 1.00 -  Female 55/95 57.9 1.93 1.63–2.37 Study cycle 0.118  Bachelor 8/26 30.8 1.00 -  Master 29/55 52.7 2.19 1.17–2.73  Doctorate 149/316 47.2 1.62 1.43–2.06 Internship in G-O 0.0005 0.0045  No 6/15 40.0 1.00 - 1.00 -  Yes 180/382 47.1 3.51 1.46–10.25 2.63 1.56–3.07 Followed an education 0.214  No 13/35 37.1 1.00 -  Yes 173/362 47.8 1.29 0.76–1.85 N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Factors associated with knowledge of risk factors for endometrial cancer N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Table 7 Distribution of students by knowledge of risk factors for ovarian cancer n  = 285* % Genetics 85 29.8 Age 76 26.7 Smoking 75 26.3 Hormonal factor 61 21.4 Family history 59 20.7 Early puberty 40 14.0 Late menopause 40 14.0 Nulliparity 40 14.0 Heredity 39 13.7 Use of oral contraceptives 26 9.1 Endometriosis 13 4.6 Obesity 6 2.1 History of breast cancer 6 2.1 Hyperoestrogenism 4 1.4 Lynch syndrome 4 1.4 Sedentary lifestyle 1 0.4 *= Number of students aware of ovarian cancer risk factors Table 8 Factors associated with knowledge of risk factors for ovarian cancer Univariate analysis Multivariate analysis n / N % OR CI 95% p -value ORa CI 95% p -value Age (years) 0.00001 0.196  [15–20[ 4∕5 80.0 1.00 - 1.00 -  [20–25[ 97∕178 54.5 1.55 1.25–2.69 1.35 1.08–2.86  [25–30[ 169∕287 58.9 2.18 1.49–2.76 1.64 1.37–2.28  [30–35[ 15∕22 68.2 2.56 1.05–3.86 2.27 1.15–3.53 Gender 0.933  Male 196∕356 55.1 1.00 -  Female 89∕136 65.4 1.78 1.02–2.44 Study cycle 0.831  Bachelor 32∕56 57.1 1.00 -  Master 44∕77 57.1 1.57 0.68–1.87  Doctorate 209∕359 58.2 1.49 0.67–2.33 Internship in G-O 0.004 0.00001  No 13∕24 54.2 1.00 - 1.00 -  Yes 272∕468 58.1 2.09 1.28–4.26 2.29 1.64–2.72 Followed an education 0.089  No 21/37 56.8 1.00 -  Yes 264/455 58.0 1.29 1.14–2.17 N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Table 9 Distribution of students by knowledge of risk factors for vaginal cancer n  = 95* % Smoking 34 35.8 HPV 31 32.1 Family history of vaginal cancer 17 17.9 Sexually transmitted infections 7 7.4 Prolonged vaginal irritation 6 6.3 Lower genital infections 5 5.3 Multiple partners 4 4.2 Hysterectomy 3 3.2 Unprotected sex 2 2.1 Vulvar or cervical cancer 2 2.1 History of pre-cancerous condition 2 2.1 Chronic vaginal infection 1 1.0 Immunodeficiency 1 1.0 HPV: Human Papilloma Virus; *= Number of students aware of vaginal cancer risk factors Table 10 Factors associated with knowledge of risk factors for vaginal cancer Univariate analysis Multivariate analysis n / N % OR CI 95% p -value ORa CI 95% p -value Age (years) 0.922  [15–20[ 0/0 0.0 1.00 -  [20–25[ 27/75 36.0 1.29 0.71–1.63  [25–30[ 62/170 36.5 1.71 1.22–2.36  [30–35[ 6/12 50.0 1.56 0.85–3.67 Gender 0.081  Male 70/192 36.5 1.00 -  Female 25/65 38.5 1.15 0.69–1.97 Study cycle 0.041 0.003  Bachelor 4/13 30.8 1.00 - 1 -  Master 14/34 41.2 1.45 1.09–3.72 1.73 1.37–2.07  Doctorate 77/210 36.7 1.22 1.01–2.65 1.69 1.51–3.22 Internship in G-O 1.34  No 8/16 50.0 1.00 -  Yes 87/241 36.1 0.96 0.42–2.43 Followed an education 1.225  No 33/125 26.4 1.00 -  Yes 62/132 47.0 1.11 0.47–2.06 N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Table 11 Distribution of students by knowledge of risk factors for vulvar cancer n  = 45* % Smoking 17 37.8 HPV 16 35.6 Personal or family history of cancer 7 15.6 Infections 5 11.1 Sexually transmitted infections 5 11.1 Immunosuppression 3 6.7 Irritation 2 4.4 History of gynaecological cancer 2 4.4 Recurrent vulvitis 2 4.4 History of cervical cancer 1 2.2 HPV: Human Papilloma Virus; *= Number of students aware of vulvar cancer risk factors Distribution of students by knowledge of risk factors for ovarian cancer *= Number of students aware of ovarian cancer risk factors Factors associated with knowledge of risk factors for ovarian cancer N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Distribution of students by knowledge of risk factors for vaginal cancer HPV: Human Papilloma Virus; *= Number of students aware of vaginal cancer risk factors Factors associated with knowledge of risk factors for vaginal cancer N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; ORa: Adjusted Odds Ratio; G-O: Gynecology Obstetrics Distribution of students by knowledge of risk factors for vulvar cancer HPV: Human Papilloma Virus; *= Number of students aware of vulvar cancer risk factors Table 12 Factors associated with knowledge of risk factors for vulvar cancer Univariate analysis n / N % OR CI 95% p -value Age (years) 2.17  [15–20[ 0/0 0.0 1.00 -  [20–25[ 15/60 25.0 1.56 0.27–2.93  [25–30[ 28/119 23.5 1.23 0.77–3.41  [30–35[ 2/13 15.4 0.83 0.31–2.06 Gender 0.554  Male 32/140 22.9 1.00 -  Female 13/52 25.0 1.92 1.42–2.91 Study cycle 1.34  Bachelor 4/16 25.0 1.00 -  Master 7/21 33.3 1.23 0.58–2.88  Doctorate 34/155 21.9 1.03 0.29–1.85 Internship in G-O 1.19  No 3/14 21.4 1.00 -  Yes 42/178 23.6 1.28 0.39–6.72 Followed an education 2.087  No 33/142 23.2 1.00 -  Yes 12/50 24.0 1.25 0.45–1.62 N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; G-O: Gynecology Obstetrics Factors associated with knowledge of risk factors for vulvar cancer N = total number of respondents with the characteristic; n = number of respondents with the same characteristic and knowledge of risk factors; OR: Odds Ratio; 95% CI: 95% Confidence Interval; G-O: Gynecology Obstetrics Of the 640 students, 62.0% acknowledged the existence of endometrial cancer risk factors. Among them, 46.9% ( n  = 186) knew the risk factors of endometrial cancer. Family history and smoking were cited by 30.6% and 21.5% of students respectively (table 5 ). There is a statistically significant association between knowing the risk factors for endometrial cancer and having completed an internship in obstetrics gynecology ( p -value = 0.0045; ORa = 2.63; 95% CI [1,56-3.07]). (table 6 ) Overall, knowledge of ovarian cancer risk factors was higher than that of endometrial cancer. Out of 640 students, 76.9% claimed that there are risk factors of ovarian cancer. Among them, 57.9% ( n  = 285) identified specific ovarian cancer risk factors. Genetics, age and smoking were cited respectively by 29.8%; 26.7% and 26.3% of students (table 7 ). There is a statistically significant association between knowing the risk factors for ovarian cancer and having completed an internship in obstetrics gynecology ( p -value = 0.00001; ORa = 2.29; 95% CI [1,64-2.72]). (table 8 ) Out of 640 students, 40.2% claimed that there are risk factors of vaginal cancer. Among them, 37.0% ( n  = 95) knew the risk factors for vaginal cancer. Smoking, HPV infection and a notion of family history of vaginal cancer were mentioned respectively by 35.8%; 30.5% and 17.9% of students (table 9 ). There is a statistically significant association between knowledge of vaginal cancer risk factors and study cycle ( p -value = 0.003). (table 10 ) Out of 640 students, 192 or 30% claimed that there are risk factors of vulvar cancer. Among them, 23% ( n  = 45) knew the vulvar cancer risk factors. Smoking, HPV infection and personal or family history of vulvar cancer were cited by 37.8%, 35.6% and 15.6% of students respectively (table 11 ). There is no statistically significant association between knowledge of vulvar cancer risk factors and socio-demographic data. (table 12 )

This was a prospective cross-sectional study with a descriptive and analytical purpose; data collection was conducted from September 1 to 31, 2021. The Faculty of Health Sciences of University of Lome served as our study framework. This faculty has qualified, internationally recognised teaching staff with rigorous teaching methods, ensuring that students receive the best possible training, particularly in the overall management of cancers. These students are key players in the cancer screening campaigns organised by the various associations in our context. The course on gynecological cancers is given to medical undergraduate to doctoral students in medicine in the context of gynecological semiology and anatomo-pathology. Master’s students in pharmacy do an internship in the obstetrics gynecology department. As for doctoral students in medicine, they benefit from an internship in the gynecology-obstetrics department. Courses in gynaecological medical semiology are given to undergraduate students; special pathology courses are given to postgraduate students; and gynaecological therapeutics is taught to doctoral students. Our study concerned all undergraduate to doctoral students in Faculty of Health Sciences, without distinction of age or sex, who have given their written informed consent to participate in the study. A total of 936 regularly enrolled students has been communicated to us by the Faculty of Health Sciences’ Registrar’s Office. The students having not correctly filled in the survey form were excluded. These were mainly those who had not specified their course of study, or whether or not they had already done a placement in the gynaecology department. The exclusion did not concern their answers to the questions on gynaecological cancer risk factors. The minimum size (n) was calculated with schwartz formula [ 9 , 12 ]: n = (t)²×p×q/d². t = value corresponding to the degree of confidence of 95%: (1.96) p = population prevalence of FSS students with knowledge of risk factors is estimated at 50%. q = 1-p=(1-0.5) = 0.5. d = desired degree of precision (0.05). n = (1.96)² × (0.5 × 0.5) / (0.05)². The minimum size n  = 385 students. The variables studied were as follows: the socio-demographic characteristics of the students, namely age, gender, field of study (medicine or pharmacy), study cycle (bachelor, master or doctorate), the fact of having completed an internship in the obstetrics gynecology department; the notion of education on gynecological cancers and sources of information and finally knowledge of the risk factors for gynecological cancers. Regarding knowledge of risk factors for gynecological cancers, students first had to answer the question of whether they know that there are risk factors of gynecological cancers. Then, those who answered “yes”, had to answer the question: “do you know the risk factors of the gynecological cancers”. Those who answered “yes” to this question had to cite the risk factors of the gynecological cancers that they know, with comparison of risk factors confirmed in the literature. The data collection technique used was based on an individual questionnaire drafted in French, including the variables studied. To ensure the validity of the questionnaire, a pre-test was carried out with 50 students; with a satisfactory positive response rate of 98.7%, and validation of the survey form without modification. The questionnaire was given to the students by the team members assigned to this task. Due to reduced availability, doctoral students received the questionnaire online via WhatsApp and Google Forms. The questionnaire comprises six parts following the introduction: a first part relating to the socio-demographic data of the student, and from the 2nd to the 6th part, the questions concerned knowledge of the different risk factors of the gynecological cancer and the different sources of information. The data was collected by three members of our research team. The data was entered into Excel software. Data from forms that did not contain information on the cycle and whether or not the patient had completed a gynaecology placement were excluded. Statistical analysis was performed with R 4.0.4 software. in the RStudio 1.4 environment. We carried out a descriptive and analytical analysis. For the descriptive analysis, the results were presented in the form of means and standard deviation for the quantitative variables and in the form of counts and proportions for the qualitative variables. Univariate and multivariate logistic regression was performed to investigate associated factors. The variables statistically associated with knowledge of the risk factors of the gynecological cancer during the univariate analysis with a degree of significance p  < 0.2 were introduced into the initial model. The multivariate analysis made it possible to estimate the adjusted odds ratio (ORa) and its 95% confidence interval for each variable used. Prior authorization number 0989 was obtained from the Dean of Faculty of Health Sciences of University of Lome, to whom we sent a letter of request for authorization explaining the objectives and methodology of the study before the start of the investigation. The questionnaire did not include any part allowing the identification of the students and before the filling of the questionnaire, an explanation was given to the students.

More than half of the students knew the risk factors for cervical cancer. However, risk factors for ovarian, endometrial, vaginal and vulvar cancers were not sufficiently known by the students. Our study reveals the importance of lectures in the faculty and hospital placements in the training of health professionals. A small proportion of students were aware of the risk factors of gynecological cancers through their personal literature. It is important for students to increase their knowledge through self-study so that they can better inform, educate and communicate with the population about the risk factors of gynecological cancers so that the population can incorporate sustainable attitudes and behavioural changes. Curricula also need to be updated to adapt them to the practical needs of students. This will involve practical workshops, discussion sessions and field trips.

Our study had certain limitations. The assessment of knowledge was based on self-reporting, leading to a possible information bias. However, it remains valuable as it assessed the knowledge of Faculty of Health Sciences students regarding gynecological cancer risk factors. The average age was 24.6 years with a standard deviation of 2.7 years and the [25–30] age group was the most represented. This average age was similar to those reported by Hsairi et al. [ 9 ] in Tunisia and Zoleikha et al. in Iran [ 13 ], which were 25.0 ± 1.4 and 25.6 ± 7.7 years respectively. Nevertheless, this average age remains lower than that reported by Halle-Ekane et al. in Cameroon [ 14 ] who were 32.3 ± 2.4 years. The average age of our respondents was higher than those reported by Serhier et al. in Morocco, which was 20.9 ± 2.1 years [ 15 ] and by Hoque et al. in South Africa, which was 19.4 ± 2.4 years [ 16 ]. The young age of the respondents in our study can be explained by their youthful student background. Indeed, the current trend is to recruit young students to the faculty, given the long course of medical and pharmaceutical studies. Male students comprised 71.3% of the sample, with a male-to-female ratio of 2.5:1. In contrast, Elbouri et al. [ 17 ] in Morocco and Hsairi et al. [ 9 ] found a predominance of females with a sex ratio of 0.38 and 0.65 respectively. This male predominance may reflect lower female enrollment in scientific fields in Togo, where the schooling rate for girls is 55% compared to 78% for boys, according to UNESCO [ 18 ]. In our study, 85.2% of the students stated that there are risk factors for cervical cancer. Of these, only 66.4% were aware of cervical cancer risk factor’s. Similarly, Tsegaye et al. [ 16 ] reported that 67.9% of students were aware of cervical cancer risk factors. In contrast, in the study by Mutyaba et al. in Uganda, only 26.0% of the health workers were aware of the risk factors of cervical cancer [ 10 ]. This relatively high response rate in both our study and that of Tsegaye et al. could be explained by our study populations, which consisted exclusively of health science students. The main sources of information were courses at the faculty (95.3%). Our results are in line with the literature. Indeed, Tsegaye et al. found that the main source was university courses (55.5%) [ 19 ]. On the other hand, in Saudi Arabia, Al-Darwish et al. found personal research to be the main source of information (38.7%) [ 20 ]. This result underlines the importance of lectures in the faculty. The most frequently cited risk factor was having multiple sexual partners (54.7%). Tsegaye et al. [ 19 ] and Al-Darwish et al. [ 20 ] found multiple sexual partners to be the most frequently risk factors cited by students in 49.7% and 75.5% of cases. These results could be explained by the popularisation of the cervical cancer teachings by all possible means. In addition, Tebeu et al. in Cameroon found the notion of multiple sexual partners (68%) as the most risk factors cited by health professionals [ 21 ]. In our study, 53.3% of the students cited Human Papilloma Virus (HPV) infection’s as a risk factor for cervical cancer. This result is similar to that of Tsegaye et al. [ 19 ] where only 49.7% of students cited this risk factor. The link between cervical cancer and sexuality could justify these results HPV (in particular strains 16 and 18) is strongly implicated in the genesis of cervical cancer, and this virus is transmitted mainly by sexual intercourse, so multiple sexual partnerships increase the risk of contracting this infection and therefore the risk of developing cervical cancer [ 22 ]. Factors associated with this knowledge in our study were age ( p -value = 0.0002), female sex ( p -value = 0.0001; aOR = 2.46; 95% CI [1.31–3.36]) and having received education about cervical cancer ( p -value = 0.0073; aOR = 1.68; 95% CI [1.25–32.08]). In contrast, Tsegaye et al. reported year of study as an associated factor [ 19 ]. The fact that cervical cancer is the most common gynecological cancer and that it is a vaccine-preventable cancer may explain the interest of women in the risk factors for this cancer. Endometrial cancer and ovarian cancer are respectively the 2nd and 3rd most common gynecological cancer after cervical cancer [ 2 ]. Knowledge of modifiable risk factors for endometrial and ovarian cancer was low among students. For endometrial cancer, only 18.3% and 7.5% of the students cited obesity and diabetes respectively as modifiable risk factors. Indeed, the latter are proven risk factors for endometrial cancer [ 23 ]. For ovarian cancer, only 26.3% and 2.1% of the students cited smoking and obesity respectively as a risk factors. This level of knowledge is quite low. Furthermore, having completed a placement in the gynaecology department was the only factor associated with knowledge of the risk factors for ovarian cancer ( p -value = 0.00001; ORa = 2.29; 95% CI [1.64–2.72]) and endometrial cancer ( p -value = 0.0045; ORa = 2.63; 95% CI [1.56–3.07]). This result indicates the importance of hospital placements in the training of health professionals, and underlines the urgent need to focus student training on the practical needs of healthcare professionals in their day-to-day working lives. Knowledge of rarer gynecological cancers was even lower. In our survey, 73.6% and 87.3% had not been taught about vaginal cancer and vulvar cancer respectively. In addition, only 37% and 23% knew the risk factors of vaginal cancer and vulvar cancer respectively. Smoking, HPV infection and sexual transmited infections were the most cited modifiable risk factors for vaginal cancer and vulvar cancer, with frequencies of 35.8%, 30.5% and 7.4% for vaginal cancer and 37.8%, 35.6% and 11.1% for vulvar cancer respectively. The rarity of these cancers and the lack of dissemination of information about them would explain the low level of knowledge [ 6 , 24 , 25 ]. Our study had certain limitations. The assessment of knowledge was based on self-reporting, leading to a possible information bias. The study was carried out in the sole faculty of health sciences in Lomé, as Togo has two faculties of health sciences. This limits the generalizability of our findings to students from the second faculty of health sciences. The convenience sampling method used in the study may introduce a selection bias because participants were chosen on the basis of their availability and attendance at classes at the faculty. Participants’ answers may be influenced by errors of understanding or by the desire to provide acceptable answers after reading documents; this may have led to an information bias. A study including students from the two health science faculties is desired in order to better extrapolate this level of knowledge about gynaecological cancers. Curricula should be updated to include more practical workshops, discussion sessions, and clinical exposure to improve students’ knowledge of gynecological cancer risk factors.

Gynecological cancers include cancers of the female reproductive system (vulva, vagina, uterus, fallopian tubes, ovaries) [ 1 ]. These cancers represent a public health issue worldwide. In 2020, gynecological cancers accounted for 7.2% of all cancers worldwide; 14.3% of cancers in Africa 14.4% of cancers in Togo [ 2 ]. In 2020, these cancers were dominated by cervical cancer, accounting for 3.1% of all cancers diagnosed, followed by cancer of the corpus uteri (2.2%) and ovarian cancer (1.6%) [ 3 ]. Gynecological cancers accounted for 20.2% of cancers in togolese women and were distributed as follows: 80.8% for the cervix; 8.3% for the uterine body; 6.4% for the ovaries; 3.2% for the vulva and 1.3% for the vagina [ 2 ]. In 2018, cervical cancer accounted for 3.2% of all cancers diagnosed. The incidence rate for cancer of the corpus uteri was 2.1%, and that for ovarian cancer was 1.6%. This reflects a slight increase in the incidence of cancer of the corpus uteri, while that of cervical cancer is decreasing [ 3 , 4 ]. The incidence of these cancers remains relatively high in sub-Saharan Africa, mainly due to the difficulty of accessing healthcare facilities, which often have limited technical facilities [ 5 ]. Gynecological cancer is an important cause of mortality and morbidity in women, diagnosis is often delayed, making it difficult to access care, and there is a shortage of specialist doctors [ 6 ]. Indeed, gynecological cancer-related deaths accounted for 26.4% of all cancer deaths in Africa and 13.3% in Togo [ 3 ]. Twenty-eight to thirty-seven% (28–37%) of gynecological cancer deaths could be prevented by early diagnosis and adequate treatment, in sub-saharan africa [ 3 ]. In Togo, awareness is very low and patients are routinely screened at an advanced stage because most of these women do not have access to early diagnosis and treatment; this is mainly due to the lack of a real screening programs, financial constraints, cultural barriers and high illiteracy rates [ 2 , 7 ]. The changing incidence rates of these gynecological cancers challenge the traditional approach to screening, and the difficulties in accessing early diagnosis and treatment guide health workers to consider risk factors [ 8 ]. The focus should then be on primary prevention by raising awareness of the risk factors of gynecological cancers. Togo has no cancer control programs, and awareness is raised mainly during the month of October, known as ‘Pink October’, by various associations, mainly those of medical and pharmacy students at the University of Lomé. In view of their active involvement in cancer screening in our context; these health science students, as future health professionals, should play a key role in informing the population about the risk factors of gynecological cancers [ 9 , 10 , 11 , 12 ]; however, there are global and regional gaps on this subject [ 1 ]. It is therefore necessary that they first have a good command of the risk factors of these gynecological cancers in order to raise awareness among the population. In Tunisia, Hsairi et al. found a general level of knowledge about cervical cancer of around 85% [ 9 ]. Less than 40% of healthcare workers were aware of the risk factors for cervical cancer in the study by Mutyaba et al. in Uganda [ 10 ]. Jonathan et al. in Congo found an average level of knowledge about cervical cancer risk factors among female students at the University of Kinshasa, of almost 40% [ 11 ]. In Togo, Darré et al. found a satisfactory level of knowledge about breast cancer among medical and pharmacy students at the University of Lomé, at around 85% [ 12 ]. The objective of this study was to assess the knowledge of Faculty of Health Sciences students on the risk factors of gynecological cancers and to determine the factors associated with this knowledge; these occupy an essential place in cancer screening in Togo, where there is no national cancer control program.