Knowledge and uptake of genital cancer screening methods among Tunisian women

Abstract

Genital cancers are amajor public health problem in Tunisia. There is limited research exploring Tunisian women’s understanding of these diseases. The aim of the present study was to assess the knowledge and uptake of genital cancer screening methods among a population of Tunisian women to investigate associations with socioeconomic status. A national cross-sectional survey of 4590 women aged 35–70 years was conducted between April and September, 2005. The protocol was approved by the Committee of the Tunisian National Council of Statistics. All participants gave informed consent. Questions on knowledge anduptake of genital cancer screeningmethodswere asked during an interview with each participant. Statistical calculations were performed using SPSS version 13.0 (SPSS Inc, Chicago, IL, USA). P b 0.05 was considered statistically significant. Overall, awareness among the participants that cancer could be located in the breasts or cervix was 69.1% (n = 3027) and there was a contrast in this awareness between urban and rural regions (78.1% vs 57.2%; P b 0.001). Among the women who were aware that cancer could be located in the genital organs, 46.9% (n = 1580) declared that they did not know any of the symptoms associatedwith genital cancers, whereas 32.5% (n = 1092) knew of more than one symptom. Only 26.3% (n= 1207) knew of one or more screening methods for genital cancers. The best known screening method was the Pap smear (41.6%; n = 463) followed by self-breast examination (40.0%; n = 445). Mammography was the least known (18.2%; n = 203). A higher level of education was associated with an increased knowledge of screeningmethods: 52.6% of womenwith a higher level of education knew of the Pap smear compared with 4.1% of women with no formal schooling (P b 0.001). In Hong Kong, level of education had no influence on knowledge of mammography and housewives were more likely to have heard of it than nonhousewives [1]. These findings suggest the importance of media as a source of information [2]. In the present study, only 22.4% (n = 971) of women declared that they had received at least one clinical breast examination. There was a significant difference according to area (27% [n = 667] urban vs 16.3% [n = 304] rural; P b 0.001); age (30.9% [n = 512 aged 34–44 years vs 11.3% [n = 138] aged N54 years; P b 0.001); and economic level (high 39.9% [n = 371] vs low 13% [n = 213]; P b 0.001) (Table 1). Almost 50% (n=2138) of women did not practice self-breast examination. The percentage who did perform self-examination was higher among urban women than rural women (56.7% [n = 1415] vs 38.6% [n = 723]) and among women aged 34–44 years compared with those aged 45–54 years or older than 54 years (59.4% [n = 991], 51.7% [n= 762], and 31.4% [n= 385]), P b 0.001). The highest percentage performing self-breast examination was observed in the most developed (according to socioeconomic indicators) region (69.8%; n = 409); and among the highest economic level group compared with the lowest (68.8% [n = 665] vs 35% [n = 578] P b 0.001). Only 8.6% (n = 368) of women declared that they had received at least one mammography screening. Similar low percentages have been observed [3] and factors that have been shown to influence the uptake of mammography are economic level and lack of health insurance [4]. In the present study, younger, more educated women from the highest economic level and those living in the coastal region have better access to mammography. Only 17% (n= 708) of women declared that they had undergone at least one Pap test. There was a significant difference according to area (21.6% [n = 515] urban vs 10.8% n = 193] rural; P b 0.001); age (21.4% [n = 344] aged 34–44 years vs 9% [n = 105] aged N54 years; P b 0.001); region (34.3% [n = 198] in most developed vs 10.3% [n = 65] in least developed); and economic level (32.7% [n = 305 highest vs 8.3% [n = 129] lowest). Assessment of women’s knowledge about screening methods is needed to understand their subsequent practices. Knowledge and uptake of genital cancer screening methods are still very low despite the implementation of a national program. The results of the present study elucidate several factors relevant for consideration in the national prevention and control program for genital cancers in Tunisia, and highlight inequity in access to screening.