Percent of women 30-49 who are aware that screening exists for cervical cancer

Definition:

The percent of women aged 30-49 who answer affirmatively when asked if they are aware that cervical cancer screening services exist. “Screening” is defined as a public health intervention used on a population at risk, or target population. Screening is not undertaken to diagnose cervical cancer, but to identify women with a high probability of having or developing it.

This indicator is calculated as:

(Number of women 30-49 who are aware that screening exists for cervical cancer / Total number of women surveyed) x 100

Data Requirement(s):

Woman’s age; response to question asking about awareness of cervical cancer screening services

Data Source(s):

Special surveys; DHS and RHS, which asks if a woman has heard of a Pap smear. However, the validity of self-reported screening has not been well established in low- and middle-income countries.

Comparable baseline data for screening coverage are available for around a quarter of all countries. But, the majority of these are program-based, not population-based nationally representative data (WHO, 2012).

Purpose:

Many women and men have not heard of cervical cancer and do not recognize early signs and symptoms when they occur. Women at risk may not know of the need to be tested, even when they do not have any symptoms, and may not realize services exist to detect existing or potential problems. Within a national cancer control program, the four basic components of cervical cancer control are: primary prevention, early detection, diagnosis and treatment, and palliative care. This indicator is related to early detection, which includes organized screening programs targeting the appropriate age group and creating awareness of cervical cancer and the services that exist to screen for it.

In resource-poor settings, 30-49 year old women comprise the target audience because cervical cancer is rare in women under 30 and most common in women over 40 years. Screening younger women will detect many lesions that will never develop into cancer, will lead to considerable overtreatment, and is not cost-effective. New programs should start by screening women aged 30 years or more, and include younger women only when the higher-risk group has been covered. If a woman can be screened only once in her lifetime, the best age is between 35 and 45 years (WHO, 2006).

Issue(s):

Respondent’s may claim to have heard of screening services simply to avoid appearing uninformed. Interviewers can confirm the respondent’s actual knowledge by asking follow-up questions about the characteristics of the method or practice. In addition to being aware that cervical cancer screening exists, evaluators may wish to evaluate the target audience’s knowledge of screening ‘services. For example, a survey question could be phrased: “Where would you go if you wanted or needed to get a Pap smear?” To determine the percent of respondents who “know” a facility, the evaluator should ensure that the responses given correspond to actual facilities (and should not simply “accept” as correct any plausible sounding location).

Keywords:

sexually transmitted infection (STI), knowledge, cervical cancer

References:

WHO. “A comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of noncommunicable diseases”. Revised WHO Discussion Paper, July 25, 2012. http://www.who.int/nmh/events/2012/discussion_paper2_20120322.pdf

WHO. Comprehensive cervical cancer control : a guide to essential practice. Switzerland, 2006. http://www.rho.org/files/WHO_CC_control_2006.pdf