Objective. To describe knowledge of the cervical cancer prevention process among rural and urban women referred for evaluation of abnormal cytology.
Materials and Methods. Women with abnormal screening cervical cytology attending university colposcopy clinics (n = 178) were asked about demographic factors and knowledge of Pap testing, human papillomavirus (HPV) infection, and risk factors for cervical cancer. Responses were tabulated, and correlations assessed.
Results. Only 131 (74%) of 176 responding women understood that Pap tests evaluate the cervix, whereas 137 (78%) understood that Pap tests should be repeated at intervals of 1-3 years. The cancer screening function of a Pap test was identified by 122/177 (69%), but only 99 (56%) knew HPV is sexually transmitted and causes warts and premalignant changes. Rural residence was not associated with knowledge, but older women were more likely to know the nature of the Pap test (p =.005) and the meaning of an abnormal Pap test (p = .04). Women in higher income strata were more likely to understand the meaning of an abnormal Pap test (p = .03), the nature of HPV (p = .005), and risk factors for cervical cancer (p = .03). College graduates were better (p = .0005), and women of greater parity were less (p = .02) able than others to identify the nature of HPV, although neither differed from others in ability to answer other questions correctly (p > .1).
Conclusions. Income and education are better predictors of knowledge of the cervical cancer prevention process than rural residence. Higher rates of cervical cancer in rural areas may reflect lower educational attainment and lower income.
Higher cervical cancer rates in rural areas may be attributable to lower educational attainment and income rather than geography.
1Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL, 2Office of Statistics and Research Consulting, Southern Illinois University School of Medicine, Springfield, IL, and 3Department of Family Medicine, Southern Illinois University School of Medicine, Springfield, IL
Reprint requests to: L. Stewart Massad, MD, Department of Obstetrics & Gynecology, Southern Illinois University, P.O. Box 19640, Springfield, IL 62794-9640. E-mail: LSMASSAD@ameritech.net