Restricted accessResearch articleFirst published online 2025
Factors influencing the decision to undergo cervical cancer screening tests (Pap Smear and HPV-DNA testing) in women aged 30–65: The role of HPV knowledge,cancer screening perception,health anxiety,and behaviors for protection against sexually transmitted diseases
This study aimed to identify factors influencing cervical cancer screening participation among women aged 30–65, focusing on HPV knowledge, cancer screening perception, health anxiety, and behaviors for protection against sexually transmitted diseases (STDs). A total of 1755 women participated, with a cervical cancer screening rate of 56.2%. Logistic regression analysis revealed several significant predictors of screening participation, including higher health anxiety, history of STDs, chronic diseases, increased HPV knowledge, positive behaviors for STDs prevention, increasing age, being married or divorced, light physical activity, healthier dietary habits, and living in the Mediterranean region. These findings highlight the interplay of demographic, psychological, and health-related factors in cervical cancer screening decisions. To improve screening rates, public health initiatives should enhance HPV knowledge, address health anxiety, and promote STDs prevention behaviors while considering regional and demographic differences. Further research should comprehensively explore how these factors interact in various settings.
Aguilar-PérezJALeyva-LópezAGAngulo-NájeraD, et al. (2003) Tamizaje en cáncer cervical: conocimiento de la utilidad y uso de citología cervical en México. Revista de Saúde Pública37(1): 100–106.
2.
AhadinezhadBMalekiAAmerzadehM, et al. (2024) What rate of Iranian women perform Pap smear test? Results from a meta-analysis. Preventive Medicine180: 107871.
3.
AhmedHAAAbbasMHHusseinHA, et al. (2024) Cervical cancer screening uptake in Arab countries: A systematic review with meta-analysis. BMC Cancer24(1): 1–14.
4.
AliMSinhaRKumarA, et al. (2024) HPV DNA status and clinical history of patients are supplements for accurate reporting of the cytological Pap smear. Scientific Reports14(1): 1–8.
5.
AsthanaSBusaVLabaniS (2020) Oral contraceptives use and risk of cervical cancer—A systematic review & meta-analysis. European Journal of Obstetrics and Gynecology and Reproductive Biology247: 163–175.
6.
AydemirOKirpinarISatiT, et al. (2013) Reliability and validity of the Turkish Version of the Health Anxiety Inventory. Archives of Neuropsychiatry50(4): 325–331.
7.
AyenewAAZewduBFNigussieAA (2020) Uptake of cervical cancer screening service and associated factors among age-eligible women in Ethiopia: Systematic review and meta-analysis. Infectious Agents and Cancer15(1): 67.
8.
BruniLSerranoBRouraE, et al. (2022) Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: A review and synthetic analysis. The Lancet Global Health10(8): e1115–e1127.
9.
CastañedaKMSidorenkovGMouritsMJE, et al. (2023) Impact of health-related behavioral factors on participation in a cervical cancer screening program: The lifelines population-based cohort. BMC Public Health23(1): 2376.
10.
ChadwickLKearsley-FleetLBrownN, et al. (2020) Cervical screening uptake and rates of cervical dysplasia in the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology59(3): 559–567.
11.
de MartelCGeorgesDBrayF, et al. (2020) Global burden of cancer attributable to infections in 2018: A worldwide incidence analysis. The Lancet Global Health8(2): e180–e190.
12.
Demir BozkurtFOzdemirS (2023) Validity and reliability of a Turkish version of the human papillomavirus knowledge scale: A methodological study. Journal of the Turkish-German Gynecological Association24(3): 177–186.
13.
DerbieAMekonnenDMisganE, et al. (2021) Low level of knowledge about cervical cancer among Ethiopian women: A systematic review and meta-analysis. Infectious Agents and Cancer16(1): 11.
14.
Dessalegn MekonnenB (2020) Cervical cancer screening uptake and associated factors among HIV-positive women in Ethiopia: A systematic review and meta-analysis. Advances in Preventive Medicine2020: 1–10.
15.
DostAOzdemirIN (2024) Women’s health literacy levels and health beliefs concerning cervical cancer and pap smear test in Türkiye. Medical Journal of Bakirkoy20: 159–167.
16.
DsouzaJPBrouckeSVDPattanshettyS, et al. (2022) A comparison of behavioural models explaining cervical cancer screening uptake. BMC Women’s Health22(1): 235.
EzechiOAkinsoluFSalakoA, et al. (2023) High-risk human papillomavirus infection among Nigerian women: A systematic review and meta-analysis. Journal of International Medical Research51(7): 3000605231182884.
19.
FaradisaEArdianaHPriyantiniD, et al. (2020) A systematic review of the factors associated with cervical cancer screening uptake among women in low and middle-income countries. Jurnal Ners15(1Sp): 113–119.
20.
FrazierELSuttonMYTieY, et al. (2016) Screening for cervical cancer and sexually transmitted diseases among HIV-infected women. Journal of Women’s Health25(2): 124–132.
21.
GeorgeJ (2021) Factors influencing utilization of cervical cancer screening services among women—A cross sectional survey. Clinical Epidemiology and Global Health11: 100752.
22.
GonzálezDSuárezELOrtizAP (2015) Cervical cancer screening and sexual risky behaviors among a population of Hispanic origin. Women’s Health Issues25(3): 254–261.
23.
GoodwinBAndersonLCollinsK, et al. (2023) Anticipatory anxiety and participation in cancer screening. A systematic review. Psycho-Oncology32(12): 1773–1786.
24.
Gul OztasHIsikK (2025) The effect of cervical cancer education given to women in Turkey on knowledge, attitudes, and health beliefs: A randomized controlled study. Public Health Nursing42(1): 363–373.
25.
HabibatullahAIWulandariAWardaniAFK (2021) Meta analysis: Health belief model on cervical cancer screening among women of reproductive age. Journal of Health Promotion and Behavior6(4): 307–317.
26.
HaileZTKingoriCChavanB, et al. (2018) Association between risky sexual behavior and cervical cancer screening among women in Kenya: A population-based study. Journal of Community Health43(2): 238–247.
27.
HuangQTanLY (2024) Exploring factors influencing cervical cancer screening participation among Singaporean women: A social ecological approach. Cancers16(20): 3475.
28.
International Collaboration of Epidemiological Studies of Cervical Cancer (2009) Cervical carcinoma and sexual behavior: Collaborative reanalysis of individual data on 15,461 women with cervical carcinoma and 29,164 women without cervical carcinoma from 21 epidemiological studies. Cancer Epidemiology, Biomarkers & Prevention18(4): 1060–1069.
29.
IssaTBabiAAzizanA, et al. (2021) Factors associated with cervical cancer screening behaviour of women attending gynaecological clinics in Kazakhstan: A cross-sectional study. Women’s Health17: 17455065211004135.
30.
KawataKKogaH (2020) Sexually transmitted infections and cervical cancer: Knowledge and prevention awareness among female university students in Japan. Nursing Open7(4): 1139–1145.
31.
KılavuzMYigitF (2023) What do I do to avoid sexually transmitted diseases? A scale development study: Behavioral scale for protection from sexually transmitted diseases. BMC Women’s Health23(1): 504.
32.
KıranSSevimFUrekD, et al. (2024) Factors affecting cancer screening perception in Turkish women: The role of health literacy. Health Promotion International39(3): daae053.
33.
LevalASundströmKPlonerA, et al. (2011) Assessing perceived risk and STI prevention behavior: A national population-based study with special reference to HPV. PLoS ONE6(6): e20624.
34.
MahmoodMIShahSAAhmadN, et al. (2018) Cancer Screening Perception Scale: Development and construct validation. Journal of Cancer Education33(2): 269–277.
35.
McFarlandDMGueldnerSMMogobeKD (2016) Integrated review of barriers to cervical cancer screening in Sub-Saharan Africa. Journal of Nursing Scholarship48(5): 490–498.
36.
NwabichieCCManafRAIsmailSB (2018) Factors affecting uptake of cervical cancer screening among African women in Klang Valley, Malaysia. Asian Pacific Journal of Cancer Prevention19(3): 825–831.
37.
OkyereJAyebengCDosooAK, et al. (2024) Cervical cancer screening among women with comorbidities: Evidence from the 2022 Tanzania demographic and health survey. BMC Public Health24(1): 1093.
38.
Olaza-MaguiñaAFDe La Cruz-RamirezYM (2019) Barriers to the non-acceptance of cervical cancer screenings (pap smear test) in women of childbearing age in a rural area of Peru. Ecancermedicalscience13: 901.
39.
Organisation for Economic Co-operation and Development (2023) Cancer screening in Health at a Glance 2023. Available at: https://stat.link/bti6lp (accessed 5 December 2024).
40.
PaolinoMArrossiS (2011) Women’s knowledge about cervical cancer, pap smear and human papillomavirus and its relation to screening in Argentina. Women & Health51(1): 72–87.
41.
PartridgeEEAbu-RustumNGiulianoA, et al. (2014) Cervical cancer screening. Journal of the National Comprehensive Cancer Network12(3): 333–341.
42.
Puig-TintoréLMCastellsaguéXTornéA, et al. (2008) Coverage and factors associated with cervical cancer screening. Journal of Lower Genital Tract Disease12(2): 82–89.
43.
PuspitasariSMurtiBPrasetyaH (2022) Meta analysis: Application of health belief model theory on pap smear screening uptake in women of reproductive age. Journal of Health Promotion and Behavior7(4): 322–335.
RichardARohrmannSSchmidSM, et al. (2015) Lifestyle and health-related predictors of cervical cancer screening attendance in a Swiss population-based study. Cancer Epidemiology39(6): 870–876.
46.
SalkovskisPMRimesKAWarwickHMC, et al. (2002) The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine32(5): 843–853.
47.
ShepherdJPFramptonGKHarrisP (2011) Interventions for encouraging sexual behaviours intended to prevent cervical cancer. Cochrane Database of Systematic Reviews2011(4): CD001035.
48.
ShresthaADAndersenJGGyawaliB, et al. (2022) Cervical cancer screening utilization, and associated factors, in Nepal: A systematic review and meta-analysis. Public Health210: 16–25.
49.
SmithAMAHeywoodWRyallR, et al. (2011) Association between sexual behavior and cervical cancer screening. Journal of Women’s Health20(7): 1091–1096.
50.
SmithSKNwosuOEdwardsA, et al. (2023) Performance of screening tools for cervical neoplasia among women in low- and middle-income countries: A systematic review and meta-analysis. PLOS Global Public Health3(2): e0001598.
51.
SozmenKUnalBSakaryaS, et al. (2016) Determinants of breast and cervical cancer screening uptake among women in Turkey. Asia Pacific Journal of Public Health28(6): 528–538.
52.
TchouaketMCTKa’eACSemengueENJ, et al. (2023) Variability of high-risk human papillomavirus and associated factors among women in sub-Saharan Africa: A systematic review and meta-analysis. Pathogens12(8): 1032.
VenturelliFSampaoloLCarrozziG, et al. (2019) Associations between cervical, breast and colorectal cancer screening uptake, chronic diseases and health-related behaviours: Data from the Italian PASSI nationwide surveillance. Preventive Medicine120: 60–70.
57.
WallerJOstiniRMarlowLAV, et al. (2013) Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory. Preventive Medicine56(1): 35–40.
YirsawANNigusieAAndualemF, et al. (2024) Cervical cancer screening utilization and associated factors among women living with HIV in Ethiopia, 2024: Systematic review and meta-analysis. BMC Women’s Health24(1): 521.
