Factors Associated with Under- and Over-Screening for Cervical Cancer in Rural Areas of Cuenca, Ecuador

Area of Science:

• Public Health
• Gynecologic Oncology
• Health Services Research

Background:

• Cervical cancer (CC) is a major global health concern, particularly in Ecuador where it is the second most prevalent cancer among women.
• Rural populations in Ecuador face challenges with inadequate cervical cancer screening, leading to both under- and overscreening.
• Effective preventive strategies exist, yet disparities in screening access and adherence persist.

Purpose of the Study:

• To determine the factors associated with both inadequate (under) and excessive (over) cervical cancer screening among women in rural Cuenca, Ecuador.
• To identify specific demographic, social, and emotional determinants influencing cervical cancer screening adherence.
• To inform the development of targeted interventions for optimizing cervical cancer screening programs.

Main Methods:

• A cross-sectional, door-to-door survey was conducted in rural parishes of Cuenca, Ecuador, from September to December 2023.
• 1692 women aged 18 and older were included, with screening status categorized based on WHO-recommended Pap test intervals (3-5 years).
• Statistical analysis, including Odds Ratios (OR) with 95% Confidence Intervals (CI), was used to identify associated factors for under- and overscreening.

Main Results:

• Nearly half (42.7%) of women were underscreened, while a substantial proportion (37.9%) were overscreened; only 19.3% were optimally screened.
• Underscreening was linked to older age (>45 years), lower education, being single, embarrassment during exams, and lack of time.
• Overscreening was associated with younger age (<45 years), higher education levels, and a strong desire for screening.

Conclusions:

• Interventions must address informational and emotional barriers to reduce underscreening and discourage unnecessary overscreening.
• Strengthening patient counseling, enhancing public education campaigns, and standardizing screening guidelines are crucial.
• Improving the efficiency and equity of cervical cancer screening programs requires tailored strategies for diverse population subgroups.