Ž .International Journal of Gynecology & Obstetrics 74 2001 305�307

Brief communication

Screening for cervical cancer among Arab women

A. Bener a,�, S. Denicb, R. Alwashc

aDepartment of Community Medicine, Faculty of Medicine & Health Sciences, United Arab Emirates Uni�ersity, Al Ain,United Arab Emirates

bDepartment of Internal Medicine, Faculty of Medicine & Health Sciences, United Arab Emirates Uni�ersity, Al Ain,United Arab Emirates

cPre�enti�e Medicine Department, Ministry of Health, Al Ain, United Arab Emirates

Received 27 December 2000; received in revised form 20 March 2001; accepted 21 March 2001

Keywords: Papanicolau test; Cervical cancer; Screening; Barriers

Screening using the Papanicolau test decreases� �mortality and morbidity from cervical cancer 1 .

Barriers to cervical cancer screening have been� �shown to exist in many countries 2�4 . We need

to know more about how knowledge and attitudesaffect screening behavior to increase screening

� �rate 2�5 . Utilization of the Pap test for cervicalcancer screening will not increase unlessknowledge is improved and barriers are elimi-nated. Information about knowledge, attitudes,barriers and practices related to cervical cancerscreening among Arab women is unavailable. Thepresent study was designed to explore those

� Corresponding author. Department of CommunityMedicine, Faculty of Medicine & Health Sciences, UnitedArab Emirates University, P.O. Box 17666, Al Ain, UnitedArab Emirates. Tel.: �971-3-7039-461; fax: �971-3-7672-022.

Ž .E-mail address: abener@uaeu.ac.ae A. Bener .

parameters in descendants of traditional Bedouinsociety who have experienced major changes inlifestyle over the past three decades because ofacquired oil wealth. The study was conductedamongst native women in the United Arab Emi-

Ž .rates UAE who are exclusively Muslim. Healthservices are free to all national citizens.

This is a cross-sectional, community-based sur-vey of UAE native women, carried out from Au-gust 1999 to February 2000. A sample of 1750married women, aged 40�65, and from 12 primaryhealth care clinics was invited to participate. Sam-pling from the clinics was proportional to 75�25%of urban�semi-urban distribution of the popula-tion. Qualified nurses interviewed subjects whoattended the clinics for any reason. Collecteddata included socio-demographic characteristicsand knowledge, attitudes and practices regardingPapanicolau screening test for cervical cancer.

0020-7292�01�$20.00 � 2001 International Federation of Gynecology and Obstetrics. All rights reserved.Ž .PII: S 0 0 2 0 - 7 2 9 2 0 1 0 0 3 9 7 - 6

( )A. Bener et al. � International Journal of Gynecology & Obstetrics 74 2001 305�307306

Single forward and back translations to Englishwere carried out to ensure linguistic validity ofthe questionnaire. Questionnaires were adminis-tered during face-to-face interviews, conducted inArabic by a health educator and one of the 10qualified nurses. Content validity, face validityand reliability of the questionnaire were tested ina sample of 50 subjects demonstrating high levelsof validity and a high degree of repeatabilityŽ .��0.82 ; 79% of self-reported Pap tests wereconfirmed in medical charts.

Of the 1750 married women invited to partici-pate, 352 refused participation, incompletely re-sponded to questionnaire or had cervical cancer,

Ž .and were excluded, leaving 1398 80% in analy-sis. Their mean age was 46.6 years, and theirmean number of annual clinic visits was 9.8Ž .range�1�30 . Pap test for early detection ofcervical cancer equalled 15.4%, a small numberconsidering that infrastructure for screening isavailable and all services are free. The Pap testwas offered by health care workers to the same

Ž .number of subjects 15.4% who had the test. Thescreening rate in the United States is 81%, andamong socially disadvantaged immigrants rate

� �varies between 34 and 76% 1�3 . In UAE, thereis no national screening policy for cervical cancer,

and physicians at their discretion or on patientrequest order the Pap tests. The responses toquestions assessing women’s knowledge about thePap test and potential barriers toward cervicalcancer screening are shown in Table 1.

In univariate analysis, four parameters wereassociated with more frequent screening for cervi-

Ž .cal cancer: age�50 vs. older age P�0.004 ;Ž .being employed vs. being a housewife P�0.001 ;

living in a semi-urban area vs. in an urban areaŽ .P�0.001 ; and less frequent visits to the clinicŽ .P�0.009 . In multivariate analysis, being em-

Ž .ployed RR�1.81, 95% CI�1.34�2.91 , living inŽa semi-urban area RR � 2.43, 95% CI �

.1.24�4.67 , and a smaller annual number of clinicŽ .visits RR�1.38, 95% CI�1.28�2.91 , were in-

dependent predictors of having a Pap test.An unexpected finding was that the residence

in suburban area was a predictor of Pap test. Wefound that a screening program was ongoing inone of the clinics in the semi-urban area, whichmay have biased the result. We did not find, likeothers, that the family income is related toscreening rate. A uniform distribution of wealthin this traditional, but wealthy society may explainthe absence of correlation between having moneyand being tested for cancer. Educating women

Table 1Knowledge and potential barriers to Pap test screening among 1398 women studied

n %

Knowledge � positi�ely answered questionsMarried women over the age of 18 should have Pap test 588 42Early cervical cancer is asymptomatic 595 43Pap test is painful 334 24Women should have regular Pap test even when not pregnant 882 63

BarriersCompletely ignorant about Pap test 105 7.5Considers Pap test unnecessary 85 6.1Lacks information where to get Pap test 101 7.2Difficulty communicating with physician 64 4.6Considers having Pap test embarrassment 87 6.2Gynecological visits are unpleasant 93 6.7Lacks time to have Pap test 81 5.8Fears bad diagnosis 73 5.2Long waiting time for Pap test 99 7.1Transportation problem 340 24

( )A. Bener et al. � International Journal of Gynecology & Obstetrics 74 2001 305�307 307

about the Pap test was shown to increase test� �acceptance 5 . Nonetheless, our study did not

find education to be a predictor of Pap test.Ž .A very high percentage of women 97% ex-

pressed preference for having a female adminis-ter a Pap test. This finding is expected amongMuslim women and was found in one study from

� �the United States 6 . That study also found thatMuslim women prefer Muslim doctors. In ourprimary health care clinics, approximately half ofthe physicians are male, most nurses are female,and most health workers are non-Muslim. It wasshown that screening programs using femalenurses for Pap test procedure were more accept-able to women.

In conclusion, the rate of Pap test among Arabwomen in the UAE is very low because the test isinfrequently offered. The Pap test was more oftenperformed by employed women who, on average,attended the clinic less often. Almost all pre-ferred a female to administer the test. Informa-tion obtained about practice, knowledge, and bar-riers toward screening should be used for devel-opment of a screening program. These findingsare relevant to populations of other wealthy Gulfcountries.

Acknowledgments

Ž .This work was supported by grant NP�99�5from the Faculty of Medicine and Health Sci-ences, UAE University, Al-Ain, Abu Dhabi,United Arab Emirates.

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