Skip to main content

Advertisement

SpringerLink
Log in

Level of Awareness Regarding Cervical Cancer Among Female Syrian Refugees in Greece

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Nowadays, prevention, control and treatment of cervical cancer are a worldwide public health priority. Primary objective of this study was to evaluate the level of awareness of female Syrian refugees who have recently settled in Greece regarding the warning signs and the risk factors of cervical cancer. This is a descriptive, cross-sectional study that was conducted in two facilities of the Hellenic Red Cross. The Cervical Cancer Awareness Measure questionnaire was addressed to 176 female Syrian refugees, aged between 18 and 50. Syrian women presented low awareness both for risk factors and warning signs. The most frequently identified warning signs were vaginal bleeding after menopause (44.3%), vaginal bleeding between menstruation (34.1%) and unexplained weight loss (32.4%). Regarding the risk factors’ recognition rates, 74.5% considered the existence of many sexual partners as a risk factor and 61.3% the existence of a sexual partner with many previous sexual partners. Older age, a higher level of education and confidence that any potential symptom would be identified were associated with increased awareness. Our findings confirm former published reports that indicate poor awareness regarding cervical cancer among refugee populations. Full compliance with the guidelines of the World Health Organization for a national cervical cancer screening programme is highly advised in Greece and should address the needs of both native and refugee populations. This research is the first one that underlines the need for raising awareness of cervical cancer among female Syrian refugees in Greece by developing health promotion strategies adjusted to their unique cultural needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. WHO, Cervical cancer. http://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/ Accessed 31 Jul 2020

  2. Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386. https://doi.org/10.1002/ijc.29210

    Article  CAS  PubMed  Google Scholar 

  3. Turkington C, Edelson M (2005) The encyclopedia of women’s reproductive cancer. Facts on file Inc., New York

    Google Scholar 

  4. Chen Y-Y, You S-L, Chen C-A, Shih L-Y, Koong S-L, Chao K-Y et al (2009) Effectiveness of national cervical cancer screening programme in Taiwan: 12-year experiences. Br J Cancer 101(1):174–177. https://doi.org/10.1038/sj.bjc.6605139

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vaccarella S, Franceschi S, Engholm G, Lönnberg S, Khan S, Bray F (2014) 50 years of screening in the Nordic countries: quantifying the effects on cervical cancer incidence. Br J Cancer 111(5):965–969. https://doi.org/10.1038/bjc.2014.362

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Nygard JF, Skare GB, Thoresen SQ (2002) The cervical cancer screening programme in Norway, 1992–2000: changes in Pap smear coverage and incidence of cervical cancer. J Med Screen 9(2):86–91. https://doi.org/10.1136/jms.9.2.86

    Article  CAS  PubMed  Google Scholar 

  7. Centers for Disease Control and Prevention (CDC) (2012) Human papillomavirus-associated cancers - United States, 2004-2008. Morb Mortal Wkly Rep 61(15):258–261

    Google Scholar 

  8. Massad LS, Einstein M, Myers E, Wheeler CM, Wentzensen N, Solomon D (2009) The impact of human papillomavirus vaccination on cervical cancer prevention efforts. Gynecol Oncol 114(2):360–364. https://doi.org/10.1016/j.ygyno.2009.04.005

    Article  PubMed  PubMed Central  Google Scholar 

  9. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE (2019) Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 68:698–702. https://doi.org/10.15585/mmwr.mm6832a3

    Article  PubMed  PubMed Central  Google Scholar 

  10. Adegboyega A, Aleshire M, Linares AM (2017) Examining cervical cancer screening utilization among African immigrant women: a literature review. Int J Womens Health Wellness 3(046):10.23937/2474-1353/1510046

    Google Scholar 

  11. McFarland DM (2003) Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions. Int Nurs Rev 50(3):167–175. https://doi.org/10.1046/j.1466-7657.2003.00195.x

    Article  CAS  PubMed  Google Scholar 

  12. Hatcher J, Studts CR, Dignan MB, Turner LM, Schoenberg NE (2011) Predictors of cervical cancer screening for rarely or never screened rural Appalachian women. J Health Care Poor Underserved 22(1):176–193. https://doi.org/10.1353/hpu.2011.0021

    Article  PubMed  PubMed Central  Google Scholar 

  13. Forney-Gorman A, Kozhimannil KB (2016) Differences in cervical cancer screening between African-American versus African-born black women in the United States. J Immigrant Minority Health 18(6):1371–1377. https://doi.org/10.1007/s10903-015-0267-0

    Article  Google Scholar 

  14. Rasul VH, Cheraghi MA, Behboodi Moqadam Z (2015) Influencing factors on cervical cancer screening from the Kurdish women’s perspective: a qualitative study. J Med Life 8(Spec Iss 2):47–54

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Abboud S, De Penning E, Brawner BM, Menon U, Glanz K, Sommers MS (2017) Cervical cancer screening among Arab women in the United States: an integrative review. Oncol Nurs Forum 44(1):E20–E33. https://doi.org/10.1188/17.ONF.E20-E33

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tung WC, Lu M, Granner M (2017) Perceived benefits and barriers of cervical cancer screening among Chinese American women. Oncol Nurs Forum 44(2):247–254. https://doi.org/10.1188/17.ONF.247-245

    Article  PubMed  Google Scholar 

  17. Toraman AU, Yildirim N (2018) Knowledge about cervical cancer risk factors and practices of pap testing among Turkish immigrant women in the United States. J Immigrant Minority Health 20(5):1222–1229. https://doi.org/10.1007/s10903-017-0653-x

    Article  Google Scholar 

  18. Hislop TG, Teh C, Lai A, Ralston JD, Shu J, Taylor VM (2004) Pap screening and knowledge of risk factors for cervical cancer in Chinese women in British Columbia, Canada. Ethn Health 9(3):267–281. https://doi.org/10.1080/1355785042000250102

    Article  PubMed  Google Scholar 

  19. Cho YG (2016) Socioeconomic disparities in cancer screening: organized versus opportunistic. Korean J fam med 37(5):261–262. https://doi.org/10.4082/kjfm.2016.37.5.261

    Article  PubMed  PubMed Central  Google Scholar 

  20. Parikh S, Brennan P, Boffetta P (2003) Meta-analysis of social inequality and the risk of cervical cancer. Int J Cancer 105(5):687–691. https://doi.org/10.1002/ijc.11141

    Article  CAS  PubMed  Google Scholar 

  21. Damiani G, Basso D, Acampora A, Bianchi CBNA, Silvestrini G, Frisicale EM, Sassi F, Ricciardi W (2015) The impact of level of education on adherence to breast and cervical cancer screening: evidence from a systematic review and meta-analysis. Prev Med 81:281–289. https://doi.org/10.1016/j.ypmed.2015.09.011

    Article  PubMed  Google Scholar 

  22. Hasan H (2009) Cervical cancer. Current and emerging trends in detection and treatment (Cancer and Modern Science). Rosen Publishing Group, New York

  23. Matin M, LeBaron S (2004) Attitudes toward cervical cancer screening among Muslim women: a pilot study. Women Health 39(3):63–77. https://doi.org/10.1300/J013v39n03_05

    Article  PubMed  Google Scholar 

  24. Morrison TB, Flynn PM, Weaver AL, Wieland ML (2013) Cervical cancer screening adherence among Somali immigrants and refugees to the United States. Health Care Women Int 34(11):980–988. https://doi.org/10.1080/07399332.2013.770002

    Article  PubMed  Google Scholar 

  25. Vahabi M, Lofters A (2016) Muslim immigrant women’s views on cervical cancer screening and HPV self-sampling in Ontario, Canada. BMC Public Health 16(1):868. https://doi.org/10.1186/s12889-016-3564-1

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sancho-Garnier H, Khazraji YC, Cherif MH, Mahnane A, Hsairi M, El Shalakamy A, Osgul N, Tuncer M, Jumaan AO, Seoud M (2013) Overview of cervical cancer screening practices in the extended Middle East and North Africa countries. Vaccine 31(Suppl 6):G51–G57. https://doi.org/10.1016/j.vaccine.2012.06.046

    Article  PubMed  Google Scholar 

  27. Sahloul E, Salem R, Alrez W, Alkarim T, Sukari A, Maziak W, Atassi MB (2017) Cancer care at times of crisis and war: the Syrian example. J Glob Oncol 3(4):338–345. https://doi.org/10.1200/JGO.2016.006189

    Article  PubMed  Google Scholar 

  28. Baghi HB, Yousefi B, Oskouee MA, Aghazadeh M (2017) HPV vaccinations: a middle eastern and north African dilemma. The Lancet Infect Dis 17(1):18–19. https://doi.org/10.1016/s1473-3099(16)30553-9

    Article  PubMed  Google Scholar 

  29. National cancer control programmes, policies and managerial guidelines (2002) 2nd ed Geneva: WHO

  30. Vakfari A, Gavana M, Giannakopoulos S, Smyrnakis E, Benos A (2011) Participation rates in cervical cancer screening: experience in rural Northern Greece. Hippokratia 15(4):346–352

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Gesouli-Voltyraki E, Tsetsekou E, Metaxa A, Borsi A, Noula M (2010) The knowledge of women in a Greek Province regarding the cervical cancer, its prevention capabilities and the Pap test. Health Sci J 4(2):101–109

    Google Scholar 

  32. Zhang Y, Ornelas IJ, Do HH, Magarati M, Jackson JC, Taylor VM (2017) Provider perspectives on promoting cervical cancer screening among refugee women. J Community Health 42(3):583–590. https://doi.org/10.1007/s10900-016-0292-5

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cancer Research UK (2008) Cervical cancer awareness measure. https://wwwcancerresearchukorg/sites/default/files/health_professional_cervical_cancer_awareness_measure_toolkit_version_21_090211pdf Accessed 31 Jul 2020

  34. Simon AE, Wardle J, Grimmett C, Power E, Corker E, Menon U, Matheson L, Waller J (2012) Ovarian and cervical cancer awareness: development of two validated measurement tools. J Fam Plann Reprod Health Care 38(3):167–174. https://doi.org/10.1136/jfprhc-2011-100118

    Article  PubMed  Google Scholar 

  35. Low EL, Simon AE, Lyons J, Romney-Alexander D, Waller J (2012) What do British women know about cervical cancer symptoms and risk factors? Eur J Cancer 48(16):3001–3008. https://doi.org/10.1016/j.ejca.2012.05.004

    Article  PubMed  Google Scholar 

  36. Siddharthar J, Bhuvaneshwari R, Deivasigamani K (2014) Knowledge, awareness and prevention of cervical cancer among women attending a tertiary care hospital in Puducherry. J Clin Diagn Res 8(6):OC01–OC03. https://doi.org/10.7860/JCDR/2014/8115.4422

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mabelele MM, Materu J, Ng’ida FD, Mahande MJ (2018) Knowledge towards cervical cancer prevention and screening practices among women who attended reproductive and child health clinic at Magu district hospital, Lake Zone Tanzania: a cross-sectional study. BMC Cancer 18(1):565. https://doi.org/10.1186/s12885-018-4490-7

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hweissa NA, Su TT (2018) Awareness of cervical cancer and socio-demographic variations among women in Libya: an exploratory study in Az-Zawiya city. Eur J Cancer Care 27(1). https://doi.org/10.1111/ecc.12750

  39. Salem MR, Amin TT, Abdulrahman A, Althafar AS, Abdelhai RA (2017) Perceived risk of cervical cancer and barriers to screening among secondary school female teachers in Al Hassa, Saudi Arabia. Asian Pac J Cancer Prev 18(4):969–979. https://doi.org/10.22034/APJCP.2017.18.4.969

    Article  PubMed  PubMed Central  Google Scholar 

  40. Haworth RJ, Margalit R, Ross C, Nepal T, Soliman AS (2014) Knowledge, attitudes, and practices for cervical cancer screening among the Bhutanese refugee community in Omaha, Nebraska. J Community Health 39(5):872–878. https://doi.org/10.1007/s10900-014-9906-y

    Article  PubMed  PubMed Central  Google Scholar 

  41. Roberts AA, Ayankogbe OO, Osisanya TF, Bamgbala AO, Ajekigbe AT, Olatunji BS, Inem VA (2004) Knowledge of cervical cancer risk factors among refugee women in Oru camp. Niger Med Pract 46(4):67–70. https://doi.org/10.4314/nmp.v46i4.28730

    Article  Google Scholar 

  42. Anaman JA, Coreea-Velez I, King J (2018) Knowledge adequacy on cervical cancer among African refugee and non-refugee women in Brisbane, Australia. J Cancer Educ 33(3):716–723. https://doi.org/10.1007/s13187-016-1126-y

    Article  PubMed  Google Scholar 

  43. WHO/Europe, Greece extends vaccination to refugees and migrants. http://www.euro.who.int/en/countries/greece/news/news/2016/04/greece-extends-vaccination-to-refugees-and-migrants Accessed 31 Jul 2020

  44. Vaidakis D, Moustaki I, Zervas I, Barbouni A, Merakou K, Chrysi MS, Creatsa G, Panoskaltsis T (2017) Knowledge of Greek adolescents on human papillomavirus (HPV) and vaccination. Medicine (Baltimore) 96(1):e5287. https://doi.org/10.1097/MD.0000000000005287

    Article  Google Scholar 

  45. Alawa J, Hamade O, Alayleh A, Fayad L, Khoshnood K (2020) Cancer awareness and barriers to medical treatment among Syrian refugees and Lebanese citizens in Lebanon. J Cancer Educ 35(4):709–717. https://doi.org/10.1007/s13187-019-01516-3

    Article  PubMed  Google Scholar 

  46. Al Qadire M, Aljezawi M, Al-Shdayfat N (2019) Cancer awareness and barriers to seeking medical help among Syrian refugees in Jordan: a baseline study. J Cancer Educ 34(1):19–25. https://doi.org/10.1007/s13187-017-1260-1

    Article  PubMed  Google Scholar 

  47. Kickbusch IS (2001) Health literacy: addressing the health and education divide. Health Promot Int 16(3):289–297. https://doi.org/10.1093/heapro/16.3.289

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This survey was conducted using the Cervical Cancer Awareness Measure, which was developed by the UCL Health Behaviour Research Centre, in collaboration with the Department of Health Cancer Team and The Eve Appeal, with funding from The Eve Appeal. It forms part of the Cervical Cancer Awareness and Symptoms Initiative (CCASI). It is based on a generic CAM developed by Cancer Research UK, the University College London, King’s College London and Oxford University in 2007–2008.

Author information

Authors and Affiliations

  1. Faculty of Social Sciences, Hellenic Open University, Patras, Greece

    Vasiliki Dalla, Anna Deltsidou, Maria Kalogeropoulou, Petros Kostagiolas, Dimitris Niakas & Georgios Labiris

  2. Medical School, Democritus University of Thrace, Alexandroupolis, Greece

    Eirini-Kanella Panagiotopoulou & Georgios Labiris

  3. Department of Midwifery, University of West Attica, Athens, Greece

    Anna Deltsidou

  4. Department of Archives, Library Science and Museology, School of Information Science and Informatics, Ionian University, Corfu, Greece

    Petros Kostagiolas

  5. Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Dimitris Niakas

Authors
  1. Vasiliki Dalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eirini-Kanella Panagiotopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Deltsidou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Kalogeropoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Petros Kostagiolas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dimitris Niakas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Georgios Labiris
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Vasiliki Dalla conceived and designed the study, involved in the acquisition of data and wrote the main manuscript. Eirini - Kanella Panagiotopoulou involved in the acquisition of data and the critical revision of the paper. Anna Deltsidou contributed to the conception and the design of the study, drafting the manuscript and the supervision of the paper. Maria Kalogeropoulou involved in the data analysis and interpretation as well as the critical revision of the paper. Petros Kostagiolas and Dimitris Niakas contributed to the conception and the design of the study and the critical revision of the paper. Georgios Labiris contributed to the conception and the design of the study, drafting the article, involved in its critical revision for important intellectual content and supervised the paper. All authors read and gave the final approval of the version to be published.

Corresponding author

Correspondence to Vasiliki Dalla.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was approved by the Hellenic Open University, and permission was granted by the Council of the Hellenic Red Cross.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dalla, V., Panagiotopoulou, EK., Deltsidou, A. et al. Level of Awareness Regarding Cervical Cancer Among Female Syrian Refugees in Greece. J Canc Educ 37, 717–727 (2022). https://doi.org/10.1007/s13187-020-01873-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-020-01873-4

Keywords

Search

Navigation