Cervical cancer and screening: knowledge, awareness and attitudes of women in Malta

Abstract

Background

Cervical cancer is an important global public health problem. It is the fourth most common cancer in females worldwide and seventh most common cancer overall. Every year (three year average, 2013-2015), there are 12 new cases of cervical cancer in Malta, which affect mostly women of working age. Since females are at the prime of their productive life, cervical cancer leads to significant psychological, social and economic strain on the affected individual and their family. The 5 year relative survival rate of CC cases for Malta was 54.73% (2000-2007), which ranks Malta as the second country with the worst 5 year survival rate in Europe. Studies have shown inequalities in the knowledge on cervical cancer and attendance for screening. Women who have lower socioeconomic status and educational level have reduced knowledge and attend less for screening than others, which places them at an increased risk of having invasive cancer of the cervix. The World Health Organisation states that early detection and treatment of cancer can be achieved through education to increase awareness of symptoms and screening programmes. This study comes at an opportune time due to recent introduction of the National Cervical Cancer Screening programme locally and aims to assess the knowledge and attitudes of 25-61 year old females, residing in Malta, on cervical cancer and screening. Methodology A cross-sectional telephone-based quantitative survey was conducted between October 2016 and February 2017. The survey tool was based on the Cervical Cancer Awareness Measure questionnaire. The tool was tested for validity and reliability and piloted. A random stratified sample, representative of the Maltese population was obtained from the Malta Identity Card Register. Data collected during the fieldwork was then analysed using univariate and multivariate logistic regression analysis.

Results 407 females between 25-64 years were interviewed giving a response rate of 85.9%. There was moderate knowledge on cervical cancer symptoms and risk factors while there was very poor awareness of the role of the Human Papillomavirus in cervical cancer. Knowledge of cervical cancer risk factors and symptoms was significantly associated with the level of education (p-value: <0.001), with the highly educated group being more knowledgeable. . 69% of the sample attended for screening every 3 years. Those who attended for screening regularly were more likely to be females with children (p-value: 0.001), having had a close family member with cancer (p-value: 0.002), and those who were in the 35-44 and 45-54 year age groups (p-value: 0.000). The main reasons for nonattendance were embarrassment, fear of the test and fear of a bad result. The findings of this study conform in most instances with results found in the international literature.

Conclusion This research is the first national representative study that provided an overview of the local knowledge, awareness and attitudes on cervical cancer and screening. There is an inequality gap between different groups of females in terms of knowledge of cervical cancer which can be reduced through health education campaigns. The outcomes also provide important information regarding the attitudes and barriers to cervical screening which can be of use in health service planning particularly in further development of the national cervical cancer screening programme.