The role of general practitioners in promoting cervical cancer screening: a field survey in a rural area of Crete, Greece

Abstract

The early detection of cervical cancer with a Papanicolaou (Pap) smear has resulted in a great decline of mortality rates in developed countries, a progress suggesting that general practice may have a crucial role in promoting screening. This study explores the impact of general practitioners on women's adherence to Pap screening recommendations in a rural area of Crete, Greece. A cross-sectional study was conducted during 2006 in a rural area of 3,000 inhabitants, where access to primary care is free of charge. A random sample of 120 women (response rate=97.5%) aged 35-75 years were interviewed about Pap smear uptake within 6 years and the influence of health professionals on their screening intentions. Adequate screening was defined according to the American Cancer Society guidelines. Multiple logistic regression analysis was applied to estimate odds ratios. About 40.8% of the respondents had been screened according to the guidelines. However, only 10.8% were recommended to have a Pap smear within the last year and 4.2% were informed about human papilloma virus. Having visited the primary care clinics for prevention or the availability of a general practitioner to consult regularly did not affect the likelihood of being screened. Both the adequate and occasional screening rates were positively associated with a history of gynecological problems and with age less than 55 years. No disparities were observed regarding socio-economic status. Despite free provision of primary care, current preventive practice has not influenced women's screening behavior. National policy to support organized cancer screening and physician' training are necessary for effective early detection of cancer.