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Abstract Ness Regarding Pap Smear and Females Practice Re- Garding Pap Smear Was Also Assessed by Four Items POPULATION AND COMMUNITY HEALTH Public Awareness and Knowledge of Pap smear as a Screening Test for Cervical Cancer among Saudi Population in Aseer Region, Saudi Arabia Hanoof Ali Alqahtani (1) Yahya Mohammed Alqahtani (2) Afnan Saeed Muqbil (2) Amal Abdullah Alqahtani (2) Mohammed Saad Aldarami (2) Amal Mohammed Alshehri (2) Manar Ahmed Alsaeedi (2) Fatimah Mosfer Alalyani (2) Amjad Ali Alsari (2) Fatimah Mubarak Alahmari (2) (1) Assistant professor of obstetrics & gynecology, Faculty of medicine, King Khalid University, Abha, Saudi Arabia. (2) Medical intern, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia Corresponding author: Yahya Mohammed Alqahtani Medical intern, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia. Tel: +966532711264 Email: [email protected] Received: January 2021; Accepted: February 2021; Published: March 1, 2021. Citation: Hanoof Ali Alqahtani et al. Public Awareness and Knowledge of Pap smear as a Screening Test for Cervical Cancer among Saudi Population in Aseer Region, Saudi Arabia. World Family Medicine. 2021; 19(3): 74-81 DOI: 10.5742/MEWFM.2021.94009 marital status, education, and job title. Female aware- Abstract ness regarding Pap smear and females practice re- garding Pap smear was also assessed by four items. Background: Cancer of the cervix is ranked the sec- ond most common female cancer worldwide (14). Results: The survey included 956 females whose Recently, it was reported to be the fourth most com- ages ranged from 18 to 65 years old. About 64% of mon female cancer. However, the disease burden the females were married and 29.9% were single. is now mainly in the less developed regions of the As for females’ awareness regarding Pap smear world. The worldwide reported significant decline in test, more than 60% of the females had heard the magnitude of cancer of the cervix in the world about Pap smear and nearly half knew its impor- especially in developed countries is attributed main- tance. Exactly 19.1% of the females reported that ly to the wide use of the Papanicolaou (Pap) smear Pap smear test should start after marriage and as an effective screening tool for cervical cancer 13.8% said that it should be done every three years. caused by human papilloma virus. If test findings Totally, a very small percentage of the females were abnormal, then more sensitive diagnostic pro- had good awareness regarding Pap smear test. cedures are required and if warranted, interventions that aim to prevent progression to cervical cancer. Conclusions: In conclusion, the study revealed that there is a great lack of knowledge regarding Pap Aim: To assess the level of public awareness, knowl- smear as a screening method of cancer of the cer- edge, and attitudes towards Pap smear as a screen- vix among Saudi females in Aseer region. The lack ing test for cervical cancer among Saudi women, at- of knowledge was more reported among highly ed- tending major healthcare facilities in the Aseer region. ucated working females. The test should be done routinely in obstetrics and gynecology departments Methodology: A descriptive cross-sectional survey of the hospitals for high-risk groups. was conducted targeting all females in Aseer region, southern Saudi Arabia aged 18 years up to 65 years. Key words: Pap smear, Pap test, cervical cancer, A direct interview questionnaire was constructed screening, cervix screening, awareness, practice, by the researchers. The questionnaire covered population females’ sociodemographic data including age, WORLD FAMILY MEDICINE/MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 19 ISSUE 3 MARCH 2021 74 MIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 7, ISSUE 10 POPULATION AND COMMUNITY HEALTH Background and had reliability coefficient (alpha Cronbach’s) of 0.76. The questionnaire covered females’ sociodemographic data including age, marital status, education and job title. The Papanicolaou test (Pap test, Pap smear) which is Female awareness regarding Pap smear was assessed also named cervical smear, cervical screening or smear using 10 questions covering its importance, proper age to test is a method of cervical screening used to detect have and to stop having the test, and frequency of doing potentially precancerous and cancerous changes in the the test. Females’ practice regarding Pap smear was also cervix or colon [1, 2]. If test findings are abnormal, then assessed by four items. more sensitive diagnostic procedures are required and if warranted, interventions that aim to prevent progression to Data analysis cervical cancer [3]. The test was independently invented After data were extracted, it was revised, coded and fed in the 1920s by Dr. Georgios Papanikolaou and Dr. into statistical software IBM SPSS version 22 (SPSS, Inc. Aurel Babeș and named after Papanikolaou. A simplified Chicago, IL). All statistical analysis was done using two version of the test was introduced by Anna Marion Hilliard tailed tests. P value less than 0.05 was considered to be in 1957 [4]. The Pap smear is performed having cells from statistically significant. For awareness items, each correct the vaginal canal at the outer opening of the cervix at the answer was scored one point and total summation of the transformation zone (where the outer squamous cervical discrete scores of the different items was calculated. A cells meet the inner glandular endocervical cells). The female with score less than 60% (5 points) of the maximum collected cells are examined under a microscope to look score was considered to have poor awareness while good for abnormalities [5]. The test remains an effective, widely awareness was considered if she had a score of 60% (6 used method for early detection of precancerous cervical points or more) of the maximum. Descriptive analysis changes or even cancer of the cervix. The test may also based on frequency and percent distribution was done detect infections and abnormalities in the endocervix and for all variables including demographic data, awareness endometrium [6]. items and females’ practice. Univariant relations between females demographic and practice data with awareness In the United States, Pap smear screening is advised at level were done based on Pearson chi-square test. the age of 21 years until the age of 65 (7). Guidelines on frequency vary from every three to five years [7-9]. If Results abnormal findings are detected, and depending on the nature of the abnormality, the test may need to be repeated The survey included 956 females whose ages ranged in six to twelve months [10]. If the abnormality requires from 18 to 65 years old. About 64% of the females were closer scrutiny, the patient may be referred for detailed married and 29.9% were single. University education was inspection of the cervix by colposcopy. The person may recorded for 77.7% of the females and 47% were working also be referred for HPV DNA testing, which can serve as an females while 25.6% were housewives (Table 1). adjunct to Pap testing. Additional biomarkers that may be applied as ancillary tests with the Pap test are evolving [11] Considering females’ awareness regarding Pap smear test, Table 2 demonstrates that 67.3% of the females had Continuous screening and females’ awareness programs heard about Pap smear and 48.3% know its importance. in the developed countries were the main factors behind Exactly 19.1% of the females reported that Pap smear test the success of Pap smear testing in these countries. should start after marriage and 13.8% said that it should Extensive screening programs and the awareness be done every three years. Only 10.8% of the females regarding the test’s importance in preventing cervical knew that Pap smear is not recommended after the age cancer was the main motive behind these assessments of 60 years and 15.7% knew the difference between Pap and intervention programs [12, 13]. The current study smear test and upper cervical smear. Totally, 13% of the aimed to assess the females’ awareness regarding Pap females had good awareness regarding Pap smear test. smear test and its importance in Aseer region, southern With regard to the source of females’ awareness (Graph Saudi Arabia. 1), obstetric and gynecology clinic was the most reported source (47.7%) followed by social media (20.4%), friends Methodology and family (16.2%) while health care providers was reported by 10% of the females. A descriptive cross-sectional survey was conducted targeting all females in Aseer region, southern Saudi As for Pap smear practice (Table 3), 22.8% of the females Arabia aged 18 years up to 65 years. A direct interview previously had undergone Pap smear and 23.2% were questionnaire was constructed by the researchers advised by their doctors to do it. Also 88.7% of the after intensive literature review. After constructing the participant females never asked their physician to do a questionnaire, five experts in the field of the questionnaire Pap smear test. topic reviewed the items independently to assess their content validity and applicability. All modifications On relating female’s awareness with their characteristics, were applied till reaching the final form. A pilot study Table 4 demonstrates that 25.6% of females with a basic was conducted to assess the tool clarity and reliability level of education had good awareness level compared including 15 females who were excluded from the final to 11.4% of those with university level with recorded study. The tool was completed within 20 minutes per case statistical significance (P=.010). Also 16.7% of housewives WORLD FAMILY MEDICINE/MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 19 ISSUE 3 MARCH 2021 MIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 7, ISSUE 10 75 POPULATION AND COMMUNITY HEALTH had good awareness level compared to 10.2% of working 21.6% of the females who were advised to undergo Pap females (P=.042).
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