Assessment of the knowledge and attitude of female students towards cervical cancer prevention at an international university in Japan

Cervical cancer resulting from prior infection with human papillomavirus (HPV) is a significant public health threat against young Japanese women. A national immunization plan to vaccinate 13~16 year old female students against HPV infection has been started in Japan since 2010, and may reach almost full coverage by the end of 2012. Older age females who may already be sexually active are not targeted by this plan but should follow safer sex practices as well as periodic screening of the cervix cytology to reduce their risk of developing cervical cancer. HPV vaccination alone does not offer full protection either, because only some HPV types are covered by the vaccines and the long-term efficacy of the vaccines has not been determined yet. Therefore, we did a survey at an international university in Japan to study the knowledge and attitude of female college students towards prevention of cervical cancer, to examine the age when they start sexual activity and other related attributes that may influence the risk of cervical cancer. We discuss the results of our survey and what they imply for the possible impact of an HPV immunization plan on the risk of cervical cancer in Japan, and conclude by an emphasis on the need to increase awareness among Japanese female adolescents and to enhance the cervical screening rates among older females who are already sexually active.     

Knowledge and Barriers Towards Cervical Cancer Screening Among Young Women in Malaysia

Objectives: This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. Methodology: A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty’s registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. Results: The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents was having more than one sex partner (77.5%), whereas the lowest was the relationship between HPV and cervical cancer (51.2%). Age, marital status, ethnicity, monthly family income and faculty were significantly associated with knowledge of cervical cancer screening (p=0.003; p=0.001; p=0.002; p=0.002; p=0.001 & p=0.002; respectively). The most common barriers of cervical cancer screening were the Pap smear test will make them worry (95.8%) whereas the least common barrier reported among participants was no encouragement from the partner (8.8%). Conclusion: Some misconceptions and barriers in uptaking Pap smear test are still serious problems among young women. Although knowledge about cervical cancer screening is adequate they have a very poor practice of Pap smear test. The introduction of reproductive health subjects is warranted for all university students.     

Knowledge and Attitudes towards Cervical Cancer Screening amongst University of Botswana Female Students

Background: Cervical cancer is the leading cause of cancer deaths in Botswana. More than two-thirds of cases occur in HIV-infected women, in a nation with a high HIV prevalence of 17%. Even though cancer screening is free in health facilities, cervical cancer screening is low. The objective of this study was to assess the knowledge and attitudes of University of Botswana female students on cervical cancer screening. Methods: A cross-sectional study was conducted among University of Botswana female students to elicit information about their knowledge and attitudes on cervical cancer screening. Results: A total of 335 students completed the questionnaire and all reported that they were aware of cervical cancer. The awareness was mostly through brochures, posters and other printed material. Regarding cervical cancer risk 315 (94%) attributed cervical cancer to smoking and 301 (89.9%) to early sexual debut. The majority of students 329 (98.2 %) were aware of cervical cancer screening. Papanicolaou (Pap) smear was the most popular screening test reported by 160 (47.8%) of the respondents as compared to Human Papilloma Virus testing (HPV) reported by 106 (31.6 %) of the respondents. The overall Pap smear screening rate was 92 of 335 students (27.5%). Those who perceived themselves to be at risk of contracting cervical cancer 203 (60.6%) where 1.8 times more likely to go for Pap smear than those who perceived to be safe, (Adjusted Odds Ratio [AOR] 1.834; 95% Confidence Interval [CI]; 1.094-3.067), (P = 0.02). Conclusions: Pap smear screening uptake is low amongst University of Botswana female students. The likely reason for this could be because students do not perceive themselves to be susceptible to cancer so the lesser the likelihood of engaging in preventive behaviours. There is urgent need for university based cancer education campaign on cervical cancer screening benefits and incorporating these campaigns into the existing university medical services to increase uptake of screening programs offered.     

Attitudes and Practice of Cervical Cancer Screening among Female University Students from 25 Low,Middle Income and Emerging Economy Countries

Cervical cancer, the third commonest cancer in women worldwide, can be prevented through early detection by cervical screening (Pap smear). The aim of this study was to investigate the attitudes and practice of cervical cancer screening among female undergraduate university students from 25 low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected from 9,194 female undergraduate university students aged 18-26 years (mean age 20.9, SD=2.0) from 26 universities in 25 countries across Asia,Africa and the Americas. Overall, 11.6% of the female students indicated that they had conducted one or more times a cervical (Pap) smear test; 8.3% among 18-20 year-olds and 15.6% among 21-26 year-old students. There was considerable country variation on having had a cervical (Pap) smear test among 21-26 year-old female university students, ranging from 59.2% in Colombia and 50.9% in Barbados to 0% in India and 1.0% in Tunesia. Logistic regression showed that cervical cancer screening importance or positive attitude were highly associatedwith the cervical screening practice. Moreover, risky sexual behaviour and tobacco use, two cervical cancer risk factors, were associated with screening. Cervical cancer screening practices were found to be inadequate and efforts should be made to develop programmes that can increase the uptake of cervical cancer screening.     

Human Papillomavirus Vaccination Acceptability among Female University Students in South Africa

Background: The objectives of this present study were to assess the awareness of cervical cancer and its riskfactors among female undergraduates in South Africa, and to determine the their level of acceptability of HumanPapillomavirus (HPV) vaccination. Materials and Methods: This cross-sectional study was conducted in March2013 among 440 full time undergraduate female students. Results: Of those students who never had sex (n=163),96 (58.9%) had ever heard of cervical cancer and only 12 students (12.5%) knew that HPV causes cervical cancer.More than a third (35.4%) of the students correctly said that sexual intercourse before age of 18 years is a riskfactor for cervical cancer and 55.2% of the students knew about the Pap smear test which is used for screeningcervical cancer. The majority (77.3%) were willing to accept HPV vaccination. Results revealed that students whoknew about the Pap smear test, and were aware that having multiple sex partners, sexual intercourse before theage of 18 years, smoking and having contracted any STDs are risk factors for cervical cancer were more likelyto accept HPV vaccination compared to other groups. Conclusions: The general knowledge of South Africanfemale university students about cervical cancer is not sufficient but they have positive attitudes toward gettingvaccinated with the HPV vaccine.     

Knowledge,Attitudes and Practices of Sudanese Women Regarding the Pap Smear Test and Cervical Cancer

Background: Despite the established role of the Pap smear test (PST) in prevention and early detection of cervical cancer, it is still rarely practiced in Sudan. Many challenges hinder the establishment of an effective cervical cancer screening program, including socio-cultural factors. Therefore, this study aimed to investigate the knowledge, attitudes and practices (KAP) of Sudanese women with regard to the Pap smear test and cervical cancer. Materials and Methods: A total of 500 married women aged 14 to 58 years were recruited from obstetric clinics, hospitals and universities in Khartoum in 2014. Data were collected using a standardized, pretested questionnaire that inquired socio-demographic characteristics and their KAP about cervical cancer and the PST. Results: More than 52% of participating women were above 30 years of age, and the majority (78.8%) were university degree holders. A total of 486 (97.2 %) of participants were resident in urban areas of Khartoum State. However about 48% of the respondents had never heard about PST, and only 15.8% of the participants had undergone a Pap smear test previously; 46.6% (233/500) knew that the human papilloma virus (HPV) was the causative agent, but only 39.2% (196/500) had heard about HPV vaccination, and only 11.4% (57/500) had received the vaccine. However 68% of the respondents agreed to do Pap smear if properly informed about the test and 75.4% of the respondents agreed to participate in a cervical cancer screening program. Conclusions: Despite a high educational level, less than half of our participants had accurate knowledge about cervical cancer, HPV, and cervical cancer screening. Health education about cervical cancer, HPV and sexually transmitted infections and the role of PST in cervical cancer prevention are crucial when designing interventions aimed at improving cervical cancer screening for Sudanese women.     

Detection of Human Papillomavirus DNA in Routine Cervical Scraping Samples: Use for a National Cervical Cancer Screening Program in a Developing Nation

Background: Human papillomavirus is a well-established cause of the development of a variety of epitheliallesions in the cervix. However, as yet, incorporation of HPV testing into cervical cancer screening either as anadjunct or stand alone test is limited due to its cost. We therefore here ascertained the presence and type specificityof human papilloma virus (HPV) DNA in routine cervical scrapings. Materials and Methods: Cervical scrapingswere collected from women attending clinics for routine Pap smear screening. HPV-DNA was detected by PCRusing MY09/11 and GP5+/GP6+ primer sets and genotyping was accomplished by cycle-sequencing. Results: Atotal of 635 women were recruited into the study with mean±SD age of 43±10.5 years. Of these 92.6% (588/635)were reported as within normal limits (WNL) on cytology. The presence of HPV infection detected by nestedMY/GP+-PCR was 4.4% (28/635). The overall prevalence of high-risk HPV (HR-HPV) in abnormal Pap smearswas 53.8% (7/13). HPVs were also seen in 3.1% (18/588) of smears reported as WNL by cytology and 5.9%(2/34) in smears unsatisfactory for evaluation. Conclusions: The overall percentage of HPV positivity in routinecervical screening samples is comparable with abnormal findings in cytology. Conventional Pap smear ‘missed’a few samples. Since HPV testing is expensive, our results may provide valuable information for strategisingimplementation of effective cervical cancer screening in a country with limited resources like Malaysia. If Papsmear coverage could be improved, HPV testing could be used as an adjunct method on cases with ambiguousdiagnoses.     

Awareness of Cervical Cancer and Pap Smear Testing Among Omani Women

Background: In developed countries, awareness of cervical cancer screening is well documented. In contrast, in Oman as a developing country, public responses regarding cervical screening are unclear. This study aimed to assess the level of awareness about cervical cancer and Papanicolau (Pap) smear testing and to establish any correlations between knowledge and demographic factors among Omani women. Methods: In this cross-sectional survey, participants were divided into three groups: patients who attended the Outpatient Gynecology Department in Sultan Qaboos University Hospital (SQUH), Oman, female staff from SQUH, College of Medicine and College of Nursing at Sultan Qaboos University (SQU) and graduating female students at SQU. Data collection was through interview-based and online self-administered questionnaires. Cumulative scoring was used for data analysis. Results: There were 204 outpatients, 133 staff and 157 students. Outpatients (79.4%), staff (97.7%) and students (75.2%) had heard of cervical cancer. Nevertheless, their specific knowledge, regarding signs and symptoms, risk factors and Pap smear, was low at 38.7%, 35.3% and 7.6% among outpatients, staff and students, respectively. Some 39.9% of the married outpatients had adequate overall knowledge as compared to none of the single women. Educational level was found to be significantly associated with outpatient knowledge with the highest awareness levels among postgraduates and medical university graduates (61.5%). Conclusion: Specific knowledge of cervical cancer, its risk factors and cervical Pap smear is generally poor among Omani women. This lack of knowledge may be one of the contributing factors for the high incidence of cervical cancer in Oman relative to that in developed countries.     

Knowledge,Behaviors, and Attitudes About Human Papilloma Virus Among Nursing Students in Izmir,Turkey

Human papillomavirus (HPV) is transmitted through sexual contact and can cause cervical cancer. The aim of this study was to determine knowledge, behaviors, and attitudes about human papillomavirus (HPV) in nursing students in a baccalaureate program. This study was conducted with a sample of 624 students. Data were collected via questionnaires administered during the first class time. Students’ knowledge about HPV was high; 90.5% knew HPV can cause cervical cancer; 94.6% recognized it as a sexually transmitted disease. Although; 87.7% stated a vaccine is available to protect women from HPV, nearly all participants (98.1%) had not received HPV vaccination. Findings show students’ level of knowledge about HPV’s risk factors and modes of transmission were high. However, this knowledge did not translate into engagement in health related behaviors such as being vaccinated against HPV.     

Factors Associated with Cervical Cancer Screening Amongst Women of Reproductive Age from Yucatan,Mexico

This study aimed to analyse the participation of women of reproductive age in a cancer screening program,and survey reasons for non-screening in a region from Mexico with high cervical cancer mortality. A total of281 obstetric patients from a previous HPV study in a social security hospital during 2008-2009 were included.Reasons for not participating in the screening were directly asked. HPV positive patients were invited toparticipate in an informative workshop, and they filled in a knowledge questionnaire. The women ranged in agefrom 14-47 years; 123 (43.8%) had never participated in screening, of which 97 (78.9%) had their first sexualintercourse 2 to 10 years ago, resulting in 25% HPV positive. Screening history was strongly associated with 2or more gestations (OR= 10.07, p=0.00) and older age (OR=6.69 p=0.00). When 197 women were contacted andinterviewed, reasons referred for non-screening were ignorance, lack of interest or time, recent sexual onset,shame and fear. More than 50% of the workshop participants showed knowledge of HPV, while 38.9% and 25%knew about Pap smear and cervical cancer. A high percentage of women of reproductive age have never had aPap smear. Promoting the screening program in medical facilities seems to be important in this population. Newapproaches to inform vulnerable individuals on the benefits of screening need to be implemented, especially foryoung women.     

HPV,Cervical Cancer and Pap Test Related Knowledge Among a Sample of Female Dental Students in India

Background: The present study was designed to ascertain knowledge about HPV, cervical cancer (CC) andthe Pap test among female dental students of Panineeya Institute of Dental Sciences and Hospital, Hyderabad,India. Materials and Methods: A self-administered questionnaire covering demographic details, knowledgerelating to human papilloma virus (HPV) (8 items), cervical cancer (4 items) and the Pap smear (6 items) wasemployed. Responses were coded as “True, False and Don’t Know”. Mean and standard deviation (SD) for correctanswers and levels of knowledge were determined. Results: Based on the year of study, significant differences inknowledge of HPV werenoted for questions on symptoms (p=0.01); transmission from asymptomatic partners(p=0.002); treatment with antibiotics (p=0.002); start of sexual activity (p=0.004); and recommended age for HPVvaccination (p=0.01). For knowledge regarding CC, significance was observed for the age group being affected(p=0.008) and symptoms of the disease in early stages (p=0.001). Indications for Pap smear tests like symptoms’ ofvaginal discharge (p=0.002), marital status (p=0.01) and women with children (p=0.02) had significant differencebased on the year of study. Based on religion, transmission of HPV via pregnancy, HPV related diseases exceptCC and preventive measures except condom use and oral contraceptives showed significant differences. However,significant variation with religion was observed only for two preventive measures of CC (Pap test; p=0.004) andHPV vaccination (p=0.003). Likewise, only the frequency of Pap test showed a significant difference for religion(p=0.001). Conclusions: This study emphasizes the lack of awareness with regard to HPV, CC and screeningwith pap smear even among health professionals. Hence, regular health campaigns are essential to reduce thedisease burden     

Opportunistic Screening for Cervical Cancer in a Tertiary Hospital in Karnataka,India

The incidence and mortality of cervical cancer remains high in India even after sixty years of introductionof the Pap smear (cervical cytology) which is an effective means of identifying preinvasive lesions of carcinomacervix. The morbidity and mortality due to cervical cancer has come down drastically in countries with wellestablished screening programmes at national level. This study aims at screening women for cervical canceropportunistically during their visit to hospital and to study various types of neoplastic and non-neoplastic lesionsof the cervix by cervical smear study (Pap smear study). In the present study, a total of 350 cervical smearswere studied. The age of patients ranged from 19 years to 80 years with mean age being 37.5 years. Out of 350cases, the diagnosis of neoplasia was given in 43 cases and 258 cases were diagnosed as inflammatory smears.Forty-cases were normal and 9 cases were inadequate to evaluate. Forty-three patients who were found to haveneoplastic lesions on cytology were referred for further investigations like colposcopy and biopsy to confirm thediagnosis and avail proper treatment. Limitation of the present study was small sample size as all female patientsaged between 20 and 60 years visiting hospital were not included in the screening, other screening tests like VIA(visual inspection with acetic acid test) and HPV DNA (human papilloma virus) tests were not done. Until thetime centrally organised screening programmes for cervical cancer are established in India, arrangements shouldbe made for hospital based opportunistic screening for all women attending hospital. The cost effectiveness ofdifferent screening tests for cervical cancer should be evaluated.     

Knowledge of cervical cancer and acceptance of HPV vaccination among secondary school students in Sarawak, Malaysia

Cervical cancer is the third most common cancer in women in peninsular Malaysia and very prevalent worldwide. HPV vaccination and routine Pap smear testing are the best preventive measures. The objective of this study was to determine the knowledge level of secondary school students from Sarawak, East Malaysia regarding cervical cancer and its prevention. Multistage random sampling with various methods in each step was employed to select the sample of 76 students. Results showed that 61.8% had poor knowledge level of cervical cancer and its prevention. There were 60.5% of students who were aware of cervical cancer with Chinese and form four students showing significantly the highest awareness (p<0.05). The main source of cervical cancer information was from their parents (25.9%). HPV vaccination acceptance among students was 22.3% and an association was found between knowledge of cervical cancer with race and HPV vaccination acceptance (p<0.05). In conclusion, the students had poor knowledge level of cervical cancer, its prevention and HPV vaccination acceptance. More efforts should be made to improve cervical cancer knowledge and awareness of the public especially secondary school students in Sarawak. This in turn will enhance the practice of prevention against cervical cancer among students.     

Screening trial of human papillomavirus for early detection of cervical cancer in Santiago,Chile

Cervical cancer mortality in Chile is four times higher than in developed countries. We compared the accuracy of human papillomavirus (HPV) DNA testing and conventional Papanicolaou (Pap) testing to detect prevalent precancerous and cancerous lesions in the routine clinical practice of the public health system. Women aged 25 years and older residing in the area covered by three primary care centers of Santiago, Chile, were invited to participate. Eligible women received both HPV DNA (Hybrid Capture 2) and Pap testing. Women positive by either test (Pap: ASCUS+, HC2: RLU/CO ≥1.0) underwent colposcopy and biopsy, as did a sample of double‐negative women with an abnormal cervix at visual inspection or with risk factors for cervical lesions. Crude and verification bias‐corrected sensitivities and specificities were estimated. In total, 8,265 women (98.8% of eligible) had complete screening results. Of these, 10.7% were HPV positive, 1.7% were Pap positive and 1.1% were positive by both tests. In all, 931 (11.3%) women were screen‐positive, of whom 94.3% attended colposcopy. Additionally, 295 control women were invited for colposcopy, of whom 78% attended. In all, 42 CIN2, 45 CIN3 and 9 cancers were identified. Verification bias‐corrected sensitivity for CIN2+ (95% confidence interval) was 92.7% (84.4–96.8) for HPV and 22.1% (16.4–29.2) for Pap; corresponding specificities were 92.0% (91.4–92.6) and 98.9% (98.7–99.0). In conclusion, in routine clinical practice in a developing country, HPV testing was four times more sensitive for CIN2+ than Pap testing, identifying three times more CIN2+ lesions; HPV testing was easily implemented in our established cervical cancer prevention program.     

Cervical Cancer and HPV Knowledge and Awareness: An Educational Intervention among College Students in Guam

Background: Compared to the U.S. population, cervical cancer (CC) incidence is significantly higher among the CHamoru, Micronesian, and Caucasian populations in Guam. From 2008-2012, CC was the fifth most common cancer diagnosed on the island. Despite the prevalence of CC and low HPV vaccine uptake, there is a concerning lack of awareness and preventative behavior among young adults.  This study was aimed at influencing college students’ knowledge and awareness of CC, CC screening, HPV, and the HPV vaccination. Methods: We delivered a 30-minute educational intervention to a sample of 108 university students in a classroom setting. The effect of the educational intervention was measured through a pre-and post-test on CC and HPV health behaviors, knowledge, and awareness. Results were analyzed using SPSS and an exact McNemar’s test was used to examine the difference in the proportion of correct answers to the tests. Two-way mixed ANOVA was used to examine between (gender, ethnicity, and class level) and within subjects (pre-and post-test) program effects. Results: Of the 108 participants, only 39 (36.1%) reported being vaccinated for HPV, 23 (21.3%) had not been vaccinated, and 46 (42.6%) did not know if they had been vaccinated for HPV.  Only forty-one (60.3%) female participants had had a Pap smear. When comparing the pre-to-posttest responses, most questions had an increase in correct responses. Time also influenced CCA and HPV knowledge and awareness scores as there was a significant increase in scores from the pre- to post-test. Conclusion: The educational intervention was an effective tool for increasing knowledge and awareness of CC, HPV, and HPV vaccination among college students. While study results demonstrate the educational intervention’s success as a baseline measure of knowledge, the inclusion of behavioral outcome measures, such as intent to get vaccinated or screened, could result in more robust future studies.     

What do women in the U.S. know about human papillomavirus and cervical cancer?

BACKGROUND: Women need to understand the link between human papillomavirus (HPV) and cervical cancer in order to make appropriate, evidence-based choices among existing prevention strategies (Pap test, HPV DNA test, and HPV vaccine). Assessment of the public's knowledge in nationally representative samples is a high priority for cervical cancer control. OBJECTIVES: To assess factors associated with U.S. women's awareness of HPV and knowledge about its link to cervical cancer. METHODS: Analyzed cross-sectional data from women ages 18 to 75 years old responding to the 2005 Health Information National Trends Survey (n = 3,076). RESULTS: Among the 40% of women who had ever heard about HPV, <50% knew it caused cervical cancer; knowledge that HPV was sexually transmitted and caused abnormal Pap tests was higher (64% and 79%, respectively). Factors associated with having heard about HPV included: younger age, being non-Hispanic White, higher educational attainment, exposure to multiple health information sources, trusting health information, regular Pap tests, awareness of changes in cervical cancer screening guidelines, and having tested positive for HPV. Accurate knowledge of the HPV-cervical cancer link was associated with abnormal Pap and positive HPV test results. CONCLUSIONS: Awareness about HPV among U.S. women is low. Having heard about HPV did not ensure accurate knowledge. Strategies for communicating accurate information about HPV transmission, prevention, and detection as well as risk and treatment of cervical cancer are needed.     

Knowledge,Attitude and Practice of the Pap Smear as aScreening Procedure Among Nurses in a Tertiary Hospital inNorth Eastern India

Background: Cancer of the uterine cervix is one of the most common cancers among women worldwide.Industrialized countries have dramatically reduced the incidence of mortality from cervical carcinoma in the last50 years through aggressive screening programs utilizing pelvic examinations and Papanicolaou (Pap) smearsbut it still remains a major problem in the developing world. Objectives: This study was performed to determineknowledge, attitude and practice of Pap smear as a screening procedure among nurses in a tertiary hospitalin north eastern India. Material and Methods: This cross sectional study was carried out with a questionnairesurvey covering the socio demographic factors, knowledge, attitude and practices about Pap smear screeningamong 224 nurses in Regional Institute of Medical Sciences, Imphal, Manipur, India during December 2011.Results: Two hundred and twenty one participants (98.6%) had heard about cervical carcinoma but 18.3%lacked adequate knowledge regarding risk factors. Knowledge about the Pap smear was adequate in 88.8% ofthe respondents. Out of these, only 11.6% had Pap smear at least once previously. The most common reasons fornon-participation in screening were lack of any symptoms (58.4%), lack of counselling (42.8%), physician doesnot request (29.9%) and fear of vaginal examination (20.5%). Conclusion: Although knowledge of Pap smear asa screening procedure for cervical cancer is high, practice is still low. The nurses who should be responsible foropportunistic screening of women they care for are not keen on getting screened themselves. If we can improvethe practice of Pap smear screening in such experts, they should be able to readily provide appropriate andaccurate information and motivate the general population to join screening programs.     

Cervical cancer in India--strategy for control.

The available information on the incidence of cancers by site in India have indicated that of incidence of cancer of uterine cervix among women is by far the highest compared to other sites in women. The epidemiology of cervical cancer has been studied extensively in India and in other countries. The majority of factors related to cervical cancer are associated with sexual behaviour. The available evidence for control of cervical cancer is through secondary prevention, namely--early detection through Pap smear. In the present communication the alternative strategies with secondary prevention for control of cervical cancer is worked out. Taking into consideration the number of cervical cancer cases saved, number of woman years saved and the cost aspects the strategy at present for India should be to provide one life time screening for women at the age of 45 years.