Cancer screening behaviors and health literacy levels of women aged 30 and over in the northwest Turkey

Abstract

The aim of this study was to determine the cancer screening behaviors and the associated factors of women aged 30 years and older during the Covid-19 pandemic period. The study was carried out as a cross-sectional study with 301 women aged 30 years and older in Edirne, which is a border province in northwestern Turkiye. The data was collected via using the Personal Information Form and the and Turkiye Health Literacy Scale-32 (THL-32). In the statistical analysis, the number, percentage, mean, standard deviation, chi-square test, pearson correlation analysis and multivariate binary logistic regression analysis were used. The mean age of the participants is 43.66 ± 9.02 years. 74.8% of the women had not undergone any screening tests during the pandemic, and 80.7% of them displayed limited and inadequate health literacy levels. 21.9% of women aged 30 and over received Pap smear screening, 22.3% of women aged 40 and over underwent mammography, and 16.7% of women aged 50 and over had screening colonoscopy. Based on the results of multivariate regression analysis, those with adequate health literacy (Odds Ratio (OR): 4.421, 95% Confidence Interval (CI): 1.114–17.539), those who had undergone breast examination performed by a physician (OR: 22.761, 95% CI: 5.930–87.364), and those who participated in papsmear screening (OR: 4.509, 95% CI: 1.605–12.672) were more likely to participate in mammography screening. Women who had a breast examination performed by a physician were also more likely to participate in pap-smear screening (OR: 1.139, 95% CI: 1.074–1.965) and colonoscopy screening (OR: 7.924, 95% CI: 2.384–26.375). The research group showed low levels of participation in cancer screening tests and low levels of health literacy. It is necessary to conduct more awareness-raising campaigns for target groups to encourage them to participate in the screening programs and to improve their health literacy.

Covid-19; Women; Cancer screening; Health literacy

[1] International Agency for Research on Cancer (IARC). World cancer report: cancer research for cancer prevention world cancer reports. 2020. Available at: https://www.iarc.who.int/cards_page/world-cancer-report/ (Accessed: 21 May 2022).

[2] Tuncez IH, Aksoy N, Koç M. National cancer screening program results; a city example. Phoenix Medical Journal. 2021; 3: 69–73.

[3] Yakşi N. How has the COVID-19 Pandemic affected cancer screening activities? International Research in Health Sciences. 2023; XIII: 77–94. (In Turkish)

[4] Turkey Ministry of Health. Turkey cancer control programme 2013–2018. 2021. Available at: https://www.iccp-portal.org/system/files/plans/Turkey%20NCCP%2018%20Apr%C4%B1l%202022.pdf (Accessed: 20 April 2022).

[5] Uslu-Sahan F, Mert-Karadas M, Yıldız T, Koc G. Effect of health literacy on the awareness of gynecological cancer among women in Turkey. Indian Journal of Gynecologic Oncology. 2023; 21: 15.

[6] Pancar N, Mercan Y. Association between health literacy and colorectal cancer screening behaviors in adults in northwestern Turkey. European Journal of Public Health. 2021; 31: 361–366.

[7] Basu P, Alhomoud S, Taghavi K, Carvalho AL, Lucas E, Baussano I. Cancer screening in the coronavirus pandemic era: adjusting to a new situation. JCO Global Oncology. 2021; 7: 416–424.

[8] Corley DA, Sedki M, Ritzwoller DP, Greenlee RT, Neslund-Dudas C, Rendle KA, et al. Cancer screening during the coronavirus disease-2019 pandemic: a perspective from the national cancer institute’s PROSPR consortium. Gastroenterology. 2021; 160: 999–1002.

[9] Miller MJ, Xu L, Qin J, Hahn EE, Ngo-Metzger Q, Mittman B, et al. Impact of COVID-19 on cervical cancer screening rates among women aged 21–65 years in a large integrated health care system—Southern California, January 1–September 30, 2019, and January 1–September 30, 2020. Morbidity and Mortality Weekly Report. 2021; 70: 109–113.

[10] Okyay P, Abacigil F, Harlak H. Turkey health literacy scale reliability and validity study. In P Okyay (ed). Turkey Health Literacy Scale (TSOY)-32 (pp. 43–60). 1st edn. Anıl Press: Ankara, Turkey. 2016.

[11] Alkatout I, Biebl M, Momenimovahed Z, Giovannucci E, Hadavandsiri F, Salehiniya H, Allahqoli L. Has COVID-19 affected cancer screening programs? A systematic review. Frontiers in Oncology. 2021;11: 675038.

[12] Villain P, Carvalho AL, Lucas E, Mosquera I, Zhang L, Muwonge R, et al. Cross‐sectional survey of the impact of the COVID‐19 pandemic on cancer screening programs in selected low-and middle-income countries: study from the IARC COVID-19 impact study group. International Journal of Cancer. 2021; 149: 97–107.

[13] DeGroff A, Miller J, Sharma K, Sun J, Helsel W, Kammerer W, et al. COVID-19 impact on screening test volume through the National Breast and Cervical Cancer early detection program, January–June 2020, in the United States. Preventive Medicine. 2021; 151: 106559.

[14] Luu T. Reduced cancer screening due to lockdowns of the COVID-19 pandemic: reviewing impacts and ways to counteract the impacts. Frontiers in Oncology, 2022; 12: 955377.

[15] Patt D, Gordan L, Diaz M, Okon T, Grady L, Harmison M, et al. Impact of COVID-19 on cancer care: how the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clinical Cancer Informatics. 2020; 26: 1059–1071.

[16] Türk Tabipleri Birliği. Aile hekimliği pandemi anketi Aralık 2020 sonuçları. 2020. Available at: https://www.ttb.org.tr/kollar/_ahek/haber_goster.php?Guid=dd35f1fc-446d-11eb-b786-a19f39419a42 (Accessed: 05 October 2021).

[17] Ismail SN, Nor Azman ND, Thomas Sudin AEL, Shamsuddin NS. Evaluation of knowledge, practice, and barriers towards breast self-examination (BSE). Malaysian Journal of Medicine & Health Sciences. 2022; 18: 190–196.

[18] Kwok C, Lee MJ, Lee CF. Breast cancer perceptions and screening behaviors among Korean women in Australia. Journal of Immigrant and Minority Health. 2020; 22: 126–133.

[19] Kwok C, Endrawes G, Lee CF. Breast cancer screening beliefs questionnaire: psychometric properties assessment of the Arabic version. European Journal of Oncology Nursing. 2016; 20: 42–48.

[20] Ngan TT, Jenkins C, Minh HV, Donnelly M, O’Neill C. Breast cancer screening practices among Vietnamese women and factors associated with clinical breast examination uptake. PLOS ONE. 2022; 17: e0269228.

[21] Othman A, Ahram M, Al-Tarawneh MR, Shahrouri M. Knowledge, attitudes and practices of breast cancer screening among women in Jordan. Health Care for Women International. 2015; 36: 578–592.

[22] National Health Service. Breast screening programme, England 2019–20. 2021. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/breast-screening-programme/england---2019-20 (Accessed: 06 January 2023).

[23] Ceyhan B, Atakır K. Özevci G. Investigation of women’s awareness of breast cancer screening methods in Turkey. Journal of Global Health & Natural Sciences. 2022; 5:123–133. (In Turkish)

[24] Altu E, Çıtıl R, Okan İ. Women's breast cancer concerns and risk factors and their approaches to cancer early diagnosis methods. Medical Research Reports. 2023; 6: 32–46. (In Turkish)

[25] Ertem G, Donmez YC, Dolgun E. Determination of the health belief and attitude of women regarding breast cancer and breast self-exam. Journal of Breast Cancer. 2017; 13: 62–66.

[26] Hocaoglu M, Ersahin AA, Akdeniz E. Evaluation on the practice and behaviour of women applied for gynecology outpatient clinics about screening methods for early diagnosis of breast cancer. European Journal of Breast Health. 2017; 13: 150–155.

[27] Sohbet R, Karasu F. Investigation of the knowledge, behavior and applications of their women towards breast cancer. Gumushane University Journal of Health Science. 2017; 6: 113–121.

[28] Kurtgöz, A, Sonkaya Zİ, Keskin S. The effect of the COVID-19 pandemic on the use of cancer early diagnosis screening and

training centers services. Balıkesir Journal of Health Sciences. 2023; 12: 195–200.

[29] Turkish Statistical Institute. Women in statistics. 2023. Available at: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Kadin-2022-49668 (Accessed: 14 September 2023).

[30] Nwabichie CC, Manaf RA, Ismail SB. Factors affecting uptake of cervical cancer screening among African women in Klang Valley, Malaysia. Asian Pacific Journal of Cancer Prevention. 2018; 27: 825–831.

[31] Karimy M, Azarpira H, Araban M. Using health belief model constructs to examine differences in adherence to pap test recommendations among Iranian women. Asian Pacific Journal of Cancer Prevention. 2017; 18: 1389–1394.

[32] Virtanen A, Anttila A, Luostarinen T, Malila N, Nieminen P. Improving cervical cancer screening attendance in Finland. International Journal of Cancer. 2015; 136: E677–84.

[33] Lo SH, Waller J, Wardle J, von Wagner C. Comparing barriers to colorectal cancer screening with barriers to breast and cervical screening: a population-based survey of screening-age women in Great Britain. Journal of Medical Screening. 2013; 20: 73–79.

[34] Simou E, Maniadakis N, Pallis A, Foundoulakis E, Kourlaba G. Factors associated with the use of pap smear testing in Greece. Journal of Women’s Health. 2010; 19: 1577–1585.

[35] Amuta-Jimenez AO, Smith G, Brown KK. Patterns and correlates of cervical cancer prevention among black immigrant and African American women in the USA: the role of ethnicity and culture. Journal of Cancer Education. 2022; 37: 798–805.

[36] Park H, Seo SH, Park JH, Keam B, Yoo SH, Shin A. The impact of the COVID-19 on the screening of breast and cervical cancer in Korea. Cancer Research. 2022; 82: 441.

[37] Hajek A, De Bock F, Huebl L, Kretzler B, König HH. Determinants of postponed cancer screening during the COVID-19 pandemic: evidence from the nationally representative COVID-19 Snapshot Monitoring in Germany (COSMO). Risk Management and Healthcare Policy. 2021; 14: 3003.

[38] World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva, World Health Organization. 2020. Available at: https://www.who.int/publications/i/item/9789240014107 (Accessed: 24 September 2022).

[39] Ginsburg O, Basu P, Kapambwe S, Canfell K. Eliminating cervical cancer in the COVID-19 era. Nature Cancer. 2021; 2: 133–134.

[40] Simms KT, Steinberg J, Caruana M, Smith MA, Lew J, Soerjomataram I, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study. The Lancet Oncology. 2019; 20: 394–407.

[41] Koo JH, Leong RWL, Ching J, Yeoh K, Wu D, Murdani A, et al. Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: a multicenter study. Gastrointestinal Endoscopy. 2012; 76: 126–135.

[42] Şahin NŞ, Üner BA. Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening in Aydın central region. The Turkish Journal of Family Practice. 2015; 19: 37–48. (In Turkish)

[43] Özdemir S, Akça H. Health literacy in Turkey. SDU Medical Faculty Journal. 2021; 28: 535–536. (In Turkish)

[44] Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). The European Journal of Public Health. 2015; 25: 1053–1058.

[45] Wittich AR, Shay LA, Flores B, De La Rosa EM, Mackay T, Valerio MA. Colorectal cancer screening: understanding the health literacy needs of Hispanic rural residents. AIMS Public Health. 2019; 6: 107–120.