Pro-health awareness of women in the context of knowledge about risk factors for cervical carcinoma

Introduction

In today’s world more and more attention is being paid to the relationship between treatment and prevention. The importance of disease prevention is often emphasised; therefore, it is worth knowing the specifics of pro-health behaviours, especially those referring to oncologic diseases [1]. The problem of cancer is becoming epidemic in the world. According to data published by the International Agency for Research on Cancer, there were around 12.7 million new cases and 7.5 million deaths in the world in the year 2008. It is predicted that in 2020, 20 million people will have cancer, half of whom will die [2].
Oncologic diseases are among the most common diseases in women [3]. Women’s health is specific because many its aspects are focused on issues related to maternity. For this reason, cancer of the reproductive organs is an important health problem. In the world, cervical carcinoma is the second most common cancer and the leading cause of death among women [4–8]. The incidence of the disease is gradually decreasing, but still remains at too high a level. On the basis of the National Cancer Registry, in 1980 the number of new cases of cervical carcinoma was 3532; however, in 2010 the number decreased to 3078. The peak incidence of the disease, which accounts for 60% of the total number, is between the ages of 45 and 65 years. The probability of the disease increases with age until the end of the sixth decade of life, and then it lowers at the time of transition to older age groups. In 2003–2005, the rate of 5-year survival was 54.4%. In Poland in 2010, the number of deaths due to cervical carcinoma was 1700, which represents 4% of the total number of women’s deaths because of cancer. Over 50% of deaths occur between the ages of 50–64 years. A comparison of the epidemiological data shows that in Poland the incidence of the disease (by 15%) and mortality (by 70%) are higher than in other European Union countries [9, 10]. However, the highest mortality is noted among new EU member countries: Romania and Lithuania. The lowest mortality is observed in Finland, Germany, and Sweden, where the introduction of screening examinations in the 1960s meant that mortality decreased by more than 80% [11–13].
The risk factors for malignant tumours of the uterine cervix are known. The cause-effect correlation between the virus of human papillomavirus (HPV), a major factor for risk of the disease, and cervical carcinoma has been documented indisputably [11, 14, 15]. In the prevention of cancer, a very important role is played by health awareness, which should be supported by practical actions, skills, and pro-health habits. It is known that cervical carcinoma is closely related to lifestyle. There is a relationship between a number of negative behaviours in the past and the occurrence of the disease in later life [7, 16, 17]. However, it is a common fact that possessed knowledge does not always translate into specific pro-health behaviours. Despite many campaigns promoting prevention, the number of women dying of this cancer is still increasing. Awareness and knowledge of the risk factors for cervical carcinoma mean that women take different actions aimed at detecting the disease in its early stages [7, 18]. Broadly understood health education should be an important point of the prevention program. It is estimated that health depends on people’s own activity and actions taken by people themselves [1, 19–21].

Aim of the research

The main aim of the research was to determine the level of awareness about the risk factors for cervical carcinoma, and an analysis of pro-health behaviours of women living in the Świętokrzyskie region. In order to accomplish the main aim of the work, the following research questions were asked:
1. How well do the women from the studied group know the risk factors for cervical carcinoma?
2. How often did the women from the studied group have cytological examinations done?
3. In what way did the women from the studied group benefit from screening?
4. In what way does knowledge about cervical carcinoma prevention affect pro-health behaviours among the surveyed women?

Material and methods

The research material was collected on the basis of a diagnostic survey, which was carried out with the use of a questionnaire survey. The obtained data underwent statistical and descriptive analysis with the use of Microsoft Excel and Gretl software. Percentages were calculated. Statistical analysis was shown with the use of the independence c2-square test. The significance level less than or equal to 0.05 was considered as a statistically significant value.
In total 108 women took part in the study, including: 26.86% (n = 29) aged 20–30 years, 24.07% (n = 26) aged 31–40 years, 25% (n = 27) aged 41–50 years, and 24.07% (n = 26) aged 51–60 years (Figure 1).
Among the respondents, 42.59% (n = 46) of the women lived in a town, and 57.41% (n = 62) lived in the countryside in Świętokrzyskie province (Figure 2).
Most of the respondents had higher education – 67 (62.04%), a smaller group consisted of women with secondary education – 31 (28.7%), and with basic vocational education there were 10 (9.26%) patients (Figure 3).

Results

Analysis of the results, answers to the survey questions, assessing the state of the women’s knowledge within the scope of cervical carcinoma prophylaxis.
Seventy-five percent (n = 81) of the surveyed women mentioned a low level of personal and sexual hygiene as the most frequent factor for cervical carcinoma. It was followed by human papillomaviruses infection (HPV) – 67.96% (n = 73) of the studied women, and smoking cigarettes by 62.96% (n = 68). Age and a large number of sexual partners were mentioned by the same number of respondents – 61.11% (n = 66), long-term use of contraceptives by 59.25% (n = 64), and early sexual intercourse by 47.22% (n = 51). Low socioeconomic status was indicated by 28.7% (n = 31) of the respondents. The lowest number of women – 24.07% (n = 26) – associate the risk of cervical carcinoma with numerous births (Figure 4).
When asked about the last visit to the gynaecologist, 57.41% (n = 62) of the women answered that it was the previous year, 25% (n = 27) said 2–3 years ago, 4.63% (n = 5) said more than 3 years ago, 9.26% (n = 10) said that they did not remember the date of the last visit, and 3.7% (n = 4) of the respondents declared that they had never been to visit the gynaecologist (Figure 5).
35.19% of the women (n = 38) had regular cytological examinations done, and 35.19% (n = 38) indicated that they occasionally had cytological examinations done; 12 04% (n = 13) of the women responded that they were only examined once, and 17.59% (n = 19) of the respondents said that they did not have cytology done at all (Figure 6).
A cytological examination was done because of the patients’ own initiative by 46.74% (n = 43) of the studied, because of a referral from the doctor by 23.91% (n = 22), because of pregnancy or childbirth by 13.04% (n = 12), and because of ailments in the reproductive organs by 7.61% (n = 7) of the patients. The same number of patients, i.e. 7.61% (n = 7), had cytological examination done as screening examinations, and 1.09% (n = 1) because of a close relative’s illness (Figure 7).
The results of the research show that pro-health behaviours depend on the level of women’s knowledge. Among the respondents with a sufficient level of knowledge, health behaviours (P) occurred in 16 (57.14%) women, while incorrect behaviours (NP) occurred in 12 (42.86%) women. In the group of women who need to deepen their knowledge, incorrect behaviours prevailed (NP) – 57 (71.25%), and proper behaviours (P) were presented only by 23 (28.75%) of the studied. Statistical analysis with the use of the chi-square test shows that there is a significant statistical relationship between the women’s knowledge about cervical carcinoma and the health behaviours presented by them. Value p was at the level of 0.007 (Table 1).

Discussion

Risk factors for cervical carcinoma are known. Correct health behaviours resulting from a proper lifestyle can reduce the likelihood of cervical carcinoma. Preventive proceedings largely depend on the woman herself. With the proper knowledge about risk factors for cervical carcinoma, as well as an individual sense of responsibility, women can consciously participate in the implementation of preventive health-related policies. Regular visits to the gynaecologist and cytological examinations significantly reduce the risk of cancer because cervical carcinoma at an early stage does not cause any ailments, which is strongly emphasised in health education [7, 11, 22].
Analysis of our own research shows that the respondents can properly recognise the causes of cervical carcinoma. According to them, the most common risk factors are: a low level of personal and sexual hygiene, human papillomavirus infection, smoking cigarettes, age, long-term use of contraceptives, and early initiation of sexual intercourse. Nowicki et al. [12] received similar results in their research; however, Czechowska [8], on the basis of a survey, found that the most commonly reported (by the respondents) factors associated with risk were: early age of sexual initiation and smoking cigarettes.
According to Derlatka [20], women occasionally have preventive examinations done as a result of campaigns that promote such examinations, especially if they are free. It proves that women lack self-initiative and the need to control their health. According to Nowicki et al. [12], more than half of the studied women from both groups saw the gynaecologist once every two years or more often, but only about 50% of the respondents from each studied group went there for prophylactic reasons. Krajewski et al. [23] showed in their study that over half of the surveyed women knew the recommendations for the frequency of cytological examinations and yet almost 50% of them had never had such an examination done. As an explanation, the respondents mentioned a lack of ailments of the reproductive organs. The authors, in their own study, observed that only 35% of women had cytological examinations done regularly, which means that women are not fully aware of the importance of prophylactic examinations. It is necessary to emphasise that women who go to the gynaecologist’s once a year and have a cytological examination done at least every 2–3 years can reduce the risk of cervical carcinoma by up to 80% [3].
Mastalerz-Migas et al. [13] states that the frequency of cytological examinations results most often from the doctor’s, not the patient’s, initiative. However, Jokel et al. [24], on the basis of research, proved that more than half of the respondents had the examination done due to their own initiative, and about 20% were directed by the doctor. The authors’ own results confirm these observations, because among women who had a cytological examination done, about 46% decided to have it due to their own initiative, and 24% on the basis of a referral from the doctor. However, the fact that only 7.6% of the respondents used the invitation to have screening done is a very unfavourable confirmation that the surveyed women are not aware of pro-health behaviours and they are not guided by responsibility for their health.
In light of the analysis of the results, it can be stated that there is a statistically significant relationship between the knowledge about cervical carcinoma, possessed by the studied women, and their health behaviours. On this basis, it can be assumed that the change in the attitude of contemporary women towards preventive measures against cervical carcinoma can be obtained through conscious and continuous education. However, in the surveyed group, the lack of coherence between possessed knowledge about the risk factors and the realisation of prophylaxis principles in life was observed. This fact proves that, as part of prophylactic measures for cervical carcinoma, it is necessary to publicise the rules of pro-health behaviours and increase the efforts towards a healthy lifestyle among the whole of society.
The presented results of the research demonstrate the need for faster development of active screening for cervical carcinoma. However, it is necessary to realise that the efforts can result in failure if the health awareness of people in Poland does not change.

Conclusions

In the study group, the majority of women could identify the risk factors for cervical carcinoma. The majority of respondents did not have regular cytological examinations done. Most of the studied women did not have screening done. Pro-health behaviours depend on the level of women’s knowledge. There is a statistically significant relationship between the knowledge about cervical carcinoma and health behaviours presented by the surveyed women. It is necessary to multiply the efforts, within preventive measures for cervical carcinoma, to promote a healthy lifestyle.

Conflict of interest

The authors declare no conflict of interest.

References

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Address for correspondence:

Anna M. Lipińska MD, PhD
Institute of Physiotherapy
Faculty of Medicine and Health Science
Jan Kochanowski University
al. IX Wieków Kielc 19, 25-317 Kielce, Poland
Phone: +48 41 349 69 54
E-mail: al.reha@wp.pl