Screening for breast and cervical cancer in a large German city: participation, motivation and knowledge of risk factors

BACKGROUND: Few data exist on attendance for cervical and breast cancer screening, breast self-examination and knowledge about risk factors for cervical cancer among German women. A population-based survey was performed in the city of Bielefeld in Germany. METHOD: A questionnaire was mailed to 1500 randomly selected women age 25 to 75. Of those, 540 questionnaires were returned and 532 were analysed. RESULTS: Women participating in the survey considered themselves well informed about possibilities for early detection of breast cancer (84.0%). Most information was received from office-based gynaecologists (82.4%). 82.8% had a breast examination by a medical doctor annually and 43.1% practised breast self-examination every month. 55.5% of the women had had a mammography, 72.5% gave screening as a reason for a mammogram. Age at first mammography was associated with social class (p<0.001). Cytological smears for early detection of cervical cancer were common and obtained frequently. Age at first Pap smear was associated with social class (p<0.001). 69.9% of the women considered themselves insufficiently informed on risk factors for cervical cancer. Women were poorly informed about risk factors for cervical cancer. Only 3.2% knew that infection with human papillomavirus (HPV) is a risk factor for cervical cancer. Giving a correct answer was associated with social class (p<0.001) but not with age. CONCLUSION: Rates of opportunistic mammography screening were high in the study population. Information on risk factors for cervical cancer was scarce. Efforts should be made to improve women's knowledge about risk factors for cervical cancer. KEY POINTS: What do German women know about screening for breast and cervical cancer offered annually by health insurances at no cost? Most women participating in the survey considered themselves well informed about possibilities for early detection of breast cancer. Over two third of the women considered themselves insufficiently informed on risk factors for cervical cancer. Only 3.2% of the women knew that infection with human papillomavirus (HPV) is a risk factor for cervical cancer. There is a pressing need in Germany for better education of the general public on risk factors for cervical cancer.