Knowledge and attitudes about the Pap-smear screening program: a population-based study of women aged 20-59 years

The aim of the Papanicolau (Pap)-smear screening program is to reduce morbidity and mortality resulting from cervix cancer. Compliance to screening has previously been suggested to be associated with women's knowledge. The aim of this study was to investigate knowledge about and attitudes to gynecologic Pap-smear screening among women in a Swedish region where a screening program has been in existence since 1970.

Questionnaires were mailed to a random sample of 400 women born 1940-79. Replies were received from 275 of the 392 (70%) available for evaluation.

Ninety-five percent of the responders had a registered Pap smear in the pathology database. Women's knowledge and concerns were age-dependent. Ninety-five percent stated that they knew the purpose of screening but only 62% could indicate which type of cancer the screening actually examined. The majority (82%) did not experience anxiety while awaiting the test result. Almost all women knew that dysplasia may not give symptoms but 10% did not consider seeking a doctor when experiencing postcoital bleeding. Fifty percent thought that their life-style may be of importance for developing dysplasia but only 13% were aware of the protective effect of a condom.

Although the vast majority of the women had experience of participating in the screening program, one in three of the women were unaware of which type of cancer she was being screened for and only half of the women were aware of the connection between dysplasia/cervix cancer and life-style factors. It is particularly important to provide better information about life-style factors in order to give women the opportunity of acting accordingly.