Women's knowledge about cervical cancer risk factors, screening, and reasons for non-participation in cervical cancer screening programme in Estonia

An anonymous questionnaire with a covering letter and a prepaid envelope was sent together with the screening invitation to 2942 randomly selected women. Results are based on the analysis of 1054 (36%) returned questionnaires.Main reasons for non-participation in the national screening programme were a recent visit to a gynaecologist (42.3%), fear to give a Pap-smear (14.3%), long appointment queues (12.9%) and unsuitable reception hours (11.8%). Fear to give a Pap-smear was higher among women aged 30 and 35 than 50 and 55 (RR 1.46; 95% CI: 0.82-2.59) and women with one or no deliveries (RR 1.56, 95% CI: 0.94-2.58). In general, awareness of cervical cancer risk factors is poor and it does not depend on socio-demographic factors. Awareness of screening was higher among Estonians than Russians (RR 1.64, 95% CI: 1.46-1.86). Most women prefer to receive information about screening from personally mailed invitation letters (74.8%).Women need more information about cervical cancer risk factors and the screening programme. They prefer personally addressed information sharing. Minority groups should be addressed in their own language. A better collaboration with service providers and discouraging smears outside the programme are also required.Estonia is one of the countries in Eastern Europe with the highest incidence and mortality rates for cervical cancer. In the year 2008, the estimated world age standardised incidence rate of cervical cancer was 19.1 per 100, 000 women-years in Estonia with 151 new cervical cancer cases being detected [1,2]. The 5-year age-standardised relative survival among cervical cancer patients diagnosed from 1990 to 1994 is 63% in Europe, and 53% for Estonia [3]. In last 25 years, the cervical cancer incidence and mortality rate in Estonia have not decreased [4]. Every year about 143-190 new cervical cancer cases are detected and about 70 women die from this disease (Estonian Cancer Registry, unpublished data). Among all malignant tumours, cervic