J Gynecol Oncol.  2010 Jun;21(2):81-86. 10.3802/jgo.2010.21.2.81.

Identifying barriers to Papanicolaou smear screening in Korean women: Korean National Health and Nutrition Examination Survey 2005

• Park SJ
• Park WS

• KMID: 2009575
• DOI: http://doi.org/10.3802/jgo.2010.21.2.81

Abstract

OBJECTIVE
This study was conducted to provide a nationwide analysis on barriers to cervical cancer screening in Korea.
METHODS
Data used for this study was obtained in a survey called Korean National Health and Nutrition Examination Survey (KNHANES) 2005, which collected data from 2,590 Korean women aged older than 21 years who had not had a hysterectomy and were eligible for Papanicolaou (Pap) smears. Multivariate analysis was adopted to control each demographic factor and unhealthy behavior variable. Demographic factors included age, education, income, job and region; health-related behavior factors were defined as current smoking, obesity, hormone replacement therapy and disability.
RESULTS
The study found that cervical cancer screening rate was significantly positively associated with income (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001 to 1.002), with education (OR, 1.324; 95% CI, 1.030 to 1.703), with job (OR, 1.420; 95% CI, 1.030 to 1.957), and with hormone replacement therapy (OR, 3.732; 95% CI, 2.354 to 5.916). Meanwhile, the age (OR, 0.977; 95% CI, 0.968 to 0.985), disability (OR, 0.358; 95% CI, 0.143 to 0.894) and smoking (OR, 0.447; 95% CI, 0.280 to 0.715) were significantly negatively associated with one's chances to take cervical cytology.
CONCLUSION
In order to increase the rates of Korean women taking Pap test, cervical cancer screening programs will have to pay special attention to the elderly, low-income group, smokers, and the disabled.

Keyword

Papanicolaou; Barrier; Korean women

MeSH Terms

Aged
Demography
Female
Hormone Replacement Therapy
Humans
Hysterectomy
Korea
Mass Screening
Multivariate Analysis
Nutrition Surveys
Obesity
Smoke
Smoking
Uterine Cervical Neoplasms
Vaginal Smears
Smoke

Reference

1. Current status of cancer occurrence and death present condition [Internet]. National Statistical Office. c2008. cited 2010 Jan 12. Daejeon: National Statistical Office;Available from: http://www.index.go.kr/egams/stts/jsp/potal/stts/.

2. Berek JS. Berek & Novak's gynecology. 2007. 14th ed. Philadelphia: Lippincott Williams & Wilkins.

3. Screening for cervical cancer recommendations and rationale 2003: U.S. Preventive Services Task Force [Internet]. Agency for Healthcare Research and Quality. cited 2010 Jan 12. Rockville: Agency for Healthcare Research and Quality;Available from: http://www.ahrq.gov/clinic/uspstf/uspscerv.htm.

4. 2008 Public Cancer Screening Investigation [Internet]. National Cancer Center. cited 2010 Jan 12. Goyang: National Cancer Center;Available from: http://ncc.re.kr/pr/notice_view.

5. Park S, Yoo I, Chang S. Relationship between the intention to repeat a papanicolaou smear test and affective response to a previous test among Korean women. Cancer Nurs. 2002. 25:385–390.

6. Fitch MI, Greenberg M, Cava M, Spaner D, Taylor K. Exploring the barriers to cervical screening in an urban Canadian setting. Cancer Nurs. 1998. 21:441–449.

7. Leary MR. A brief version of the fear of negative evaluation scale. Pers Soc Psychol Bull. 1983. 9:371–375.

8. Holroyd E, Twinn SF, Shia AT. Chinese women's experiences and images of the Pap smear examination. Cancer Nurs. 2001. 24:68–75.

9. Park SM. Factors related to continuous participation in the Pap smear screening among Korean women: using a structural model [dissertation]. 1999. Seoul: Yonsei University.

10. Lin SJ. Factors influencing the uptake of screening services for breast and cervical cancer in Taiwan. J R Soc Promot Health. 2008. 128:327–334.

11. Lee HJ, Lee SH, Jung SH, Shin HR, Oh DK. Analysis of behavioral stage in pap testing by using transtheoretical model. J Prev Med Public Health. 2005. 38:82–92.

12. Leach CR, Schoenberg NE. The vicious cycle of inadequate early detection: a complementary study on barriers to cervical cancer screening among middle-aged and older women. Prev Chronic Dis. 2007. 4:A95.

13. Liu SY, Clark MA. Breast and cervical cancer screening practices among disabled women aged 40-75: does quality of the experience matter? J Womens Health (Larchmt). 2008. 17:1321–1329.

14. Armour BS, Thierry JM, Wolf LA. State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Womens Health Issues. 2009. 19:406–414.

15. Lavela SL, Weaver FM, Smith B, Chen K. Disease prevalence and use of preventive services: comparison of female veterans in general and those with spinal cord injuries and disorders. J Womens Health (Larchmt). 2006. 15:301–311.

16. Cohen SS, Palmieri RT, Nyante SJ, Koralek DO, Kim S, Bradshaw P, et al. Obesity and screening for breast, cervical, and colorectal cancer in women: a review. Cancer. 2008. 112:1892–1904.

17. Wee CC, McCarthy EP, Davis RB, Phillips RS. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med. 2000. 132:697–704.

18. Mitchell RS, Padwal RS, Chuck AW, Klarenbach SW. Cancer screening among the overweight and obese in Canada. Am J Prev Med. 2008. 35:127–132.

19. Juon HS, Choi Y, Kim MT. Cancer screening behaviors among Korean-American women. Cancer Detect Prev. 2000. 24:589–601.

20. Park S, Chang S, Chung C. Effects of a cognition-emotion focused program to increase public participation in Papanicolaou smear screening. Public Health Nurs. 2005. 22:289–298.

21. Fang CY, Ma GX, Tan Y, Chi N. A multifaceted intervention to increase cervical cancer screening among underserved Korean women. Cancer Epidemiol Biomarkers Prev. 2007. 16:1298–1302.

22. Lee EE, Fogg L, Menon U. Knowledge and beliefs related to cervical cancer and screening among Korean American women. West J Nurs Res. 2008. 30:960–974.

23. Krenz V, Pinzon-Perez H, Krenz E, Perez M, Haugan P. Barriers to Pap smears among latina medical enrollees using GIS. GIS presentation. 2003. 7:1–11.

24. Feresu SA, Zhang W, Puumala SE, Ullrich F, Anderson JR. Breast and cervical cancer screening among low-income women in Nebraska: findings from the Every Woman Matters program, 1993-2004. J Health Care Poor Underserved. 2008. 19:797–813.

25. Carruth AK, Browning S, Reed DB, Skarke L, Sealey L. The impact of farm lifestyle and health characteristics: cervical cancer screening among southern farmwomen. Nurs Res. 2006. 55:121–127.

26. Nelson W, Moser RP, Gaffey A, Waldron W. Adherence to cervical cancer screening guidelines for U.S. women aged 25-64: data from the 2005 Health Information National Trends Survey (HINTS). J Womens Health (Larchmt). 2009. 18:1759–1768.

27. Weinstein ND, Marcus SE, Moser RP. Smokers' unrealistic optimism about their risk. Tob Control. 2005. 14:55–59.

28. Ayanian JZ, Cleary PD. Perceived risks of heart disease and cancer among cigarette smokers. JAMA. 1999. 281:1019–1021.

29. Strecher VJ, Kreuter MW, Kobrin SC. Do cigarette smokers have unrealistic perceptions of their heart attack, cancer, and stroke risks? J Behav Med. 1995. 18:45–54.

30. Schoenbaum M. Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey. Am J Public Health. 1997. 87:755–759.

31. Moran S, Glazier G, Armstrong K. Women smokers' perceptions of smoking-related health risks. J Womens Health (Larchmt). 2003. 12:363–371.

32. Weinstein ND. Accuracy of smokers' risk perceptions. Ann Behav Med. 1998. 20:135–140.

33. Massak A, Graham K. Is the smoking-depression relationship confounded by alcohol consumption? An analysis by gender. Nicotine Tob Res. 2008. 10:1231–1243.

34. Gonzalez A, Zvolensky MJ, Vujanovic AA, Leyro TM, Marshall EC. An evaluation of anxiety sensitivity, emotional dysregulation, and negative affectivity among daily cigarette smokers: relation to smoking motives and barriers to quitting. J Psychiatr Res. 2008. 43:138–147.

35. Doran N, McChargue D, Spring B. Effect of impulsivity on cardiovascular and subjective reactivity to smoking cues. Addict Behav. 2008. 33:167–172.