Cervical cancer is a major public health problem throughout the world. Cervical cancer is the forth most common cancer in women worldwide . The Pap smear it can decrease the incidence of cervical cancer due to early detection. Good awareness about Pap smear screening and the risk factors for cervical cancer decrease the associated mortality and morbidity. In the present study, we show low percentage of the participants were aware to risk factors for cervical cancer and more than half of married women were aware of Pap smear testing, although few of them had been screened. In total, a third of participants were aware that HPV is a cause of cervical cancer. A study conducted in Jeddah, Saudi Arabia, showed that low percentage of women were aware of the link between HPV and cervical cancer . A similar study conducted in Riyadh showed that a third of participants were aware of HPV and 27.4% were aware of its relationship within cervical cancer . Furthermore, in a study conducted in Tanzania, less than half of the nurses who participated had adequate awareness regarding cervical cancer . In comparison, a study conducted in Saudi Arabia showed a good overall knowledge level about cervical cancer (78.6%), although the knowledge regarding HPV (16.4%) was low. A similar study conducted in Malaysia (88.8%) revealed a high level of knowledge about cervical cancer .
Among the married participants, approximately half were aware of the Pap smear test, but only 14.2% had been screened. Of the participants tested, 69.9% did so on the advice of a physician. In total, 56.7% of the participants had no awareness of the screening test and 18.9% considered it unnecessary. In a similar study conducted in Jeddah, 67.6% of participants were aware of the Pap smear test, but only 16.8% had been screened, mainly due to lack of awareness . In comparison, a study in Eastern Nigeria revealed that 41.5% of participants were aware of the Pap smear test but, only 20.5% had been screened, with most of these participants considering the test to be unnecessary . Also, another study in Al-Ahsa showed that 55.4% of participants were aware of the Pap smear test, but only 11.2% had been screened . Participants in this study also reported pain and fear of results as reasons for not being screened. These findings are consistent with another study in which fear was reported as a barrier to screening .
Vaccination against HPV decreases the morbidity and mortality of cervical cancer. Therefore, a high level of awareness about cervical cancer may result in increased uptake of screening and the implementation of such preventive strategies. Our study showed that 88.1% of participants accepted that cervical cancer is preventable, of which 57.2% were aware of the availability of a vaccine, although only 14.8% had been vaccinated on the advice of a physician or social media. In comparison with other studies in Saudi Arabia, only 20.8% of participants in a study conducted in Mecca were aware of the HPV vaccine and only 1.4% had actually been vaccinated . Moreover, in the study in Al-Ahsa, only 21.1% of participants were aware of the HPV vaccine, and only 2.1% had received the vaccine .
Multiple logistic regression analyses in our study showed that age, education level, occupation, family history and monthly income had a significant effect on awareness of risk factors for cervical cancer, Pap smear testing and vaccination. The ages of the participants with good awareness of cervical cancer age ranged from 30 to 39 years. Also, in terms of occupation, the participants working in healthcare or in the medical field had good awareness. Furthermore, participants with a family history of cancer and monthly income exceeding 15,000 SR had a good awaerness.
The finding of our study highlight the need to educate women about risk factors for cervical cancer and the benefits of preventive measures such as Pap smear testing and vaccination. Such strategies will be important in increasing the uptake of Pap smear screening and vaccination. Implementation of screening and vaccination programs delivered through schools, universities, healthcare providers, social media and home visiting will improve the awareness of cervical cancer.