Perceived Risk of Cervical Cancer and Barriers to Screening among Secondary School Female Teachers in Al Hassa, Saudi Arabia

Anticipatory anxiety and participation in cancer screening. A systematic review

OBJECTIVES

To synthesize current evidence on the association between anticipatory anxiety, defined as apprehension-specific negative affect that may be experienced when exposed to potential threat or uncertainty, and cancer screening to better inform strategies to maximize participation rates.

METHODS

Searches related to cancer screening and anxiety were conducted in seven electronic databases (APA PsycINFO, Scopus, Web of Science, Embase, Cochrane Library, PubMed, CINAHL), with potentially eligible papers screened in Covidence. Data extraction was conducted independently by multiple authors. Barriers to cancer screening for any type of cancer and relationships tested between anticipatory anxiety and cancer screening and intention were categorized and compared according to the form and target of anxiety and cancer types.

RESULTS

A total of 74 articles (nparticipants  = 119,990) were included, reporting 103 relationships tested between anticipatory anxiety and cancer screening and 13 instances where anticipatory anxiety was reported as a barrier to screening. Anticipatory anxiety related to a possible cancer diagnosis was often associated with increased screening, while general anxiety showed no consistent relationship. Negative relationships were often found between anxiety about the screening procedure and cancer screening.

CONCLUSION

Anticipatory anxiety about a cancer diagnosis may promote screening participation, whereas a fear of the screening procedure could be a barrier. Public health messaging and primary prevention practitioners should acknowledge the appropriate risk of cancer, while engendering screening confidence and highlighting the safety and comfort of screening tests.

Cervical Cancer Screening Barriers Among Citizens of Jeddah

INTRODUCTION

The cervix, a cylindrical structure made of stroma and epithelium, is the lowest point of the uterus. A tissue-proven biopsy of the cervix with histological confirmation is necessary for aberrant cytologic results of Papanicolaou (Pap) smears to rule out cervical cancer. This study investigates barriers to cervical cancer screening among women.

METHODOLOGY

 A cross-sectional study including 665 Saudi Arabian women residing in Jeddah between the ages of 21 and 65 years was carried out from May to November 2023. A four-part online survey was used to gather the data, which included questions about demographics, cervical cancer screening status, screening barriers, and predictors of cervical cancer screening.

RESULTS

The most common barrier to Pap test screening was "have not been to a doctor/no regular provider" (39.7%, N = 251), followed by "lack of provider recommendation/or limited or no information in the community" (30.4%, N = 192) and "low priority/did not perceive need/being healthy" (27.7%, N = 175).

CONCLUSION

The study provides valuable insights into the factors influencing cervical cancer screening in Jeddah, Saudi Arabia. The low prevalence of screening indicates a need for increased awareness and targeted interventions to improve uptake.

Socio-Demographic Factors and Other Predictors of Pap Test Uptake Among Women: A Retrospective Study in Ghana

Introduction

The World Health Organization has reported a rise in cervical cancer in Ghana. Ghanaian women predominantly undergo opportunistic Pap smear screening for cervical cancer. Numerous studies have documented differences in the sociodemographic traits of participants undergoing Pap smear testing or screening, which correlates with their screening habits. This study aims to assess sociodemographic variables, including others that determine Pap test utilization at a single center in Ghana.

Methods

A single-center survey was conducted by extracting data from the records of women who walked in for Pap smear testing. A telephone survey was also conducted among these women to document their barriers to utilizing the center. For data analysis, descriptive statistics and chi-square were utilized.

Results

A total of 197 participants' records were retrieved for the study. Most participants were market women (69.4%) and uneducated (71.4%). Their Pap smear screening records indicate that the majority (86%) had no history of cervical cancer screening, and only 3% tested positive for Pap smear test. Educational level, occupation and family history of cancer significantly correlated with participants' Pap smear history (p<0.05). However, most sociodemographic factors were not significant with the Pap test results of the participants (p>0.05). The perceived barrier identified by most participants was the need for more information (67.40%) on the test.

Conclusion

This study revealed that sociodemographic and gynaecological factors do not correlate with Pap test results. However, education level, occupation, and family history of cancer were significantly associated with the history of Pap smear uptake. The most significant barrier hindering Pap smear services was the need for more information.

Level of Awareness Regarding Cervical Cancer Among Female Syrian Refugees in Greece

Nowadays, prevention, control and treatment of cervical cancer are a worldwide public health priority. Primary objective of this study was to evaluate the level of awareness of female Syrian refugees who have recently settled in Greece regarding the warning signs and the risk factors of cervical cancer. This is a descriptive, cross-sectional study that was conducted in two facilities of the Hellenic Red Cross. The Cervical Cancer Awareness Measure questionnaire was addressed to 176 female Syrian refugees, aged between 18 and 50. Syrian women presented low awareness both for risk factors and warning signs. The most frequently identified warning signs were vaginal bleeding after menopause (44.3%), vaginal bleeding between menstruation (34.1%) and unexplained weight loss (32.4%). Regarding the risk factors' recognition rates, 74.5% considered the existence of many sexual partners as a risk factor and 61.3% the existence of a sexual partner with many previous sexual partners. Older age, a higher level of education and confidence that any potential symptom would be identified were associated with increased awareness. Our findings confirm former published reports that indicate poor awareness regarding cervical cancer among refugee populations. Full compliance with the guidelines of the World Health Organization for a national cervical cancer screening programme is highly advised in Greece and should address the needs of both native and refugee populations. This research is the first one that underlines the need for raising awareness of cervical cancer among female Syrian refugees in Greece by developing health promotion strategies adjusted to their unique cultural needs.

Cervical Cancer Screening Uptake and Predictors Among Women in Jeddah, Saudi Arabia

INTRODUCTION

Cervical cancer is one of the most common cancers among females, contributing to significant mortality and morbidity worldwide. These numbers have significantly decreased since the implementation of cervical cancer screening. Despite that, screening in many countries, including Saudi Arabia, remains suboptimal.

METHODS

A cross-sectional study was conducted between May to November 2021 among 385 women aged 21-65 years who live in Jeddah, Saudi Arabia. The data were collected using a four-part online survey: demographic characteristics, cervical cancer screening status, predictors of undergoing cervical cancer screening, and barriers to screening.

RESULTS

Among the 385 women who completed the survey, only around one-third (33.4%) had a Pap smear at some point in their lives. The factors that were found to be significantly associated with the screening status (having a Pap test) in the univariate analysis are increasing age, education level, monthly income, perceived risk of getting cervical cancer, source of information about Pap test, having a family doctor, recommendation by the family doctor to have a Pap test, undergoing a gynecological examination, visiting a gynecologist in the past, history of previous gynecological complaint, and history of abortion. In the multivariable analysis, only four factors were found to be significantly associated with the screening status: age, monthly income, undergoing a gynecological examination in the past, and the recommendation by the family doctor, which by far had the largest effect.

CONCLUSION

Cervical cancer screening rate is relatively low in the city of Jeddah. The recommendation of a Pap test by the family doctor had the largest impact on screening status. These results support the important role of family physicians in promoting screening tests for preventive healthcare. The results also suggest the need for education programs to promote cervical cancer screening among women in Saudi Arabia.

Awareness and Practices Related to Cervical Cancer among Females in Saudi Arabia

Human papilloma virus (HPV) is the most common risk factor for cervical cancer. Cervical cancer can be prevented with vaccination and early screening methods using pap smears. However, the acceptance of these approaches can be affected by the awareness level of the population. This cross-sectional study aimed to assess knowledge and practices related to cervical cancer among women in the Al Madinah Province in Saudi Arabia. A total of 1489 responses were included in the analysis. The median awareness score related to cervical cancer was eight out of 20 points. Vaginal bleeding, dyspareunia, and leg pain were correctly identified by 79.8%, 43.7%, and 19.3% of the women, respectively. Thirty-four percent of the study sample knew that the sexually transmitted virus is a risk factor for cervical cancer. Only 44.6% were able to correctly identify pap smear as a screening tool, and 12.6% knew that there was a HPV vaccine. This study revealed a low to moderate awareness level toward cervical cancer, pap smear, and HPV vaccine. Thus, awareness campaigns are urgently needed to increase the awareness level for early detection and prevention of the disease.

Human papillomavirus and its vaccination: Knowledge and attitudes among female university students in Saudi Arabia

Context:

College students worldwide have low levels of knowledge on human papillomavirus (HPV)-related diseases, highlighting the lack of awareness about HPV infection. To date, no study has examined the level of knowledge of cervical cancer and the HPV vaccine in the northern region of Saudi Arabia.

Aim:

This study aimed to assess the level of knowledge of cervical cancer and its risk factors, as well as HPV vaccine acceptance among female students in Saudi Arabia enrolled in health colleges.

Methods:

A descriptive cross-sectional survey was conducted using a valid and reliable self-administered questionnaire. The questionnaire was completed by 966 female students enrolled at the University of Hail, northern region of Saudi Arabia, with a response rate of 83.5%. The main outcome measure was the identification of the knowledge gap pertaining to HPV infection and its prophylactic vaccine.

Results:

The findings highlighted a lack of knowledge about cervical cancer, Pap smears, and HPV vaccine among most female university students. The knowledge score positively correlated to the duration of education. Students enrolled in applied medical science and medical colleges showed significantly higher knowledge scores, as did students in their senior academic years. Vaccine uptake barriers included concerns about its side effects and a lack of information.

Conclusions:

Our findings can be used to formulate effective future awareness programs in the northern region of Saudi Arabia. A larger number of educational programs are required to enlighten Saudi women about cervical cancer and its prophylactic vaccine, including the benefits of screening programs and prevention strategies.

Knowledge, attitude and practice towards early screening of colorectal cancer in Riyadh

Background and Aims:

Colorectal cancer (CRC) is a common cause of mortality worldwide. It is preventable, treatable when detected early. The aim of this study is to assess knowledge, attitude and practice (KAP) of the participants toward CRC and its early screening, and identify the sources of information on the subjects.

Methods:

We conducted a cross-sectional study on the people 40y old and above at the primary care clinics at King Saud university medical city (KSUMC) in Riyadh. The estimated sample size was 245 subjects whom we requested to complete a self-administered Arabic questionnaire, which consisted of three parts. These were: 1. Demographic data, 2. KAP toward CRC, its early detection. 3 sources of information of the public about colorectal cancer.

Results:

A total of 231 subjects participated; (54.5%) were male (mean age = 50.7 ± 9.8). About 47% of the participants heard about cancer screening, and 45% knew that colonoscopy is used for such purposes. Another 24.2% were aware that occult blood in the stool test is a method of early detection of colon cancer. About 40% to 50% of the subjects were knowledgeable about hazardous factors and cautioning symptoms for CRC. Only 6.5% of the subjects did an early screening for CRC, but 82.9% would do it if their doctor advised them to do so.

Conclusion:

The participant's knowledge and early checkups of CRC are inadequate. They would undergo early screening if their doctors advised them to do so. It is time to develop a national policy for CRC screening involving primary care doctors and utilizing social media to improve people's information.

Indicators of survival and prognostic factors in women treated for cervical cancer at a tertiary care center in Saudi Arabia

BACKGROUND

Investigating survival in cervical cancer at the local level is crucial to determine the effectiveness of overall management, as it reflects the level of care provided and awareness among the population about screening and early diagnosis.

OBJECTIVES

Analyze overall survival (OS) and disease-free survival (DFS) among patients treated for cervical cancer and to investigate clinical, management- and outcome-related independent factors associated with survival.

DESIGN

A retrospective medical record review.

SETTING

Gynecology oncology unit in a tertiary care center.

PATIENTS AND METHODS

All women with cervical cancer who were treated and followed up between January 1999 and December 2017. Baseline demographic and clinical data, tumor characteristics, treatment options and outcomes including recurrence were collected and analyzed as factors and predictors of survival.

MAIN OUTCOME MEASURES

OS and DFS among patients treated for cervical cancer.

SAMPLE SIZE

190 patients.

RESULTS

The 190 patients had a mean (SD) age of 54.2 (13.1) years (median 52.0, interquartile range, 46-62), and median (IQR) follow-up time was 37.0 (12.0-69.0) months. Tumor characteristics showed FIGO stage (I [19.0%], II [48.9%], III [18.4%], IV [13.6%]), grade (I [15.8%], II [46.8%], III [35.8%]) and the most frequent histological type was squamous cell carcinoma (77.4%). Patients received initial radiotherapy with concurrent chemotherapy (53.2%), initial radical hysterectomy (24.7%), systemic chemotherapy (6.3%) and palliative care (4.7%). Mean OS and DFS were 97.1 (82.2, 111.9) and 85.2 (70.4, 100.0) months, respectively. Recurrence and mortality rates were 25.8% and 46.8%, occurring after a median (IQR) time=13.0 (6.0-28.0) and 20.0 (9.0-45.0) months, respectively. Survival was independently associated with grade II (hazard ratio [HR]=3.6, 95%CI: 1.3-9.7, P=.012), grade III (HR=4.5, 95%CI:1.6-12.6, P=.004), number of regional organs involved (1-3 organs: HR=7.8, 95%CI: 1.2, 49.1, P=.030), and recurrence (HR=2.23, P=.001).

CONCLUSION

Survival was about 8 years in our institution, which is predicted by the tumor grade, regional organs involved and recurrence. Remarkably, this study found a high percentage of patients diagnosed at an advanced stage, which probably impacts survival and stresses the need for improving early detection.

LIMITATIONS

Retrospective design, resulting in recall bias and missing data.

CONFLICT OF INTEREST

None.

Differential Impact of Education Level, Occupation and Marital Status on Performance of the Papanicolaou Test among Women from Various Regions in Brazil

Background: In Brazil, little is known regarding the underlying causes of differences among populations regarding socio-economic variables that affect women’s cervical cancer screening behavior. The present study focused on socio-economic variables that affect women’s performance of the Papanicolaou test, comparing two distinct Brazilian populations. Methods: We collected data regarding performance of the Papanicolaou test and socio-economic variables from 559 women in Mato Grosso do Sul (MS), in the Central East region, and 338 women in Paraíba (PB), in the Northeast region of Brazil. Nominal logistic regression modeling was performed to identify independent variables for both groups of data. Results: Of the women interviewed from MS and PB, 116 out of 599 (19.37%) and 94 out of 338 (27.81%), respectively, had not performed the Papanicolaou test within the last three years (p = 0.025). Low educational level characterized 570 (95.16%) and 203 (60.06%) of women from MS and PB, respectively (p = 0.000). Women in PB who had a low educational level and were unemployed had a 2.96-fold (OR = 0.338; 95% CI: 0.121 - 0.939) and 2.40-fold (OR = 0.416; 95% CI: 0.199 - 0.869) lower chance, respectively, to have performed the Papanicolaou test ≥ three times, or once within the last three years (p = 0.029; p = 0.014). The chance of women in MS who did not live in a stable relationship to have performed the test ≥ three times was 1.79-fold (OR = 0.560; 95% CI: 0.348 – 0.901) lower compared to women who reported a stable relationship (p = 0.039). Conclusions: High educational level, employment, and having a stable interpersonal relationship positively associated with performance of the Papanicolaou test among women in PB and MS. Despite having predominantly a low educational level, women in MS performed the Papanicolaou test more frequently than those in PB.

Using the health belief model to assess beliefs and behaviors regarding cervical cancer screening among Saudi women: a cross-sectional observational study

Background

Cervical cancer in Saudi Arabia is ranked as the third most frequent gynecological cancer among women. The Pap smear test is a screening test that can be used as a primary prevention tool for cervical cancer, and prophylactic vaccination against HPV is also considered to be a factor in decreasing the prevalence of the disease. This study aimed to assess women’s beliefs about cervical cancer and the Pap smear test. In addition, the relationship between cervical cancer and the social and demographic characteristics was also evaluated.

Methods

A descriptive cross-sectional study was performed among Saudi women living in Riyadh in 2018. Women were randomly selected, and the total sample size was 450. A predesigned self-administered questionnaire that included the Health Belief Model scale was used to collect data. Data were analyzed using SPSS 21.0. P values < 0.05 were considered as statistically significant in this study.

Results

Among the 450 participants, the Pap smear test uptake was 26% and the HPV vaccine uptake was less than 1%. A low education level and family history for cervical cancer were significantly associated with the belief of high susceptibility for developing cervical cancer (p < 0.05). The seriousness of the disease was recognized by 38%, and the benefit of screening was recognized by 82% of the participants. In addition, 27% of the participants perceived barriers to obtaining a Pap smear test.

Conclusions

This study showed a high level of perception regarding benefits and motivation, and a low incidence of perceived barriers among women regarding cervical cancer screening. However, these attitudinal aspects did not translate into practice, as reflected by the low uptake of the screening test. Our findings imply that concerted efforts are needed to promote cervical cancer screening programs in Saudi Arabia. In view of the planned implementation of Saudi vision 2030, which emphasizes on prevention, we recommend launching a national cervical cancer screening program, to be available and accessible to all women in primary health care centers and hospitals.