Barriers to Pap-smear Testing From the Viewpoint of Postmenopausal Women in Kashan.

Dear Editor,

According to the World Health Organization report in September 2013, cervical cancer was the second common cancer in women. It is estimated that 530000 new cases are diagnosed with cervical cancer annually (1). There is a reliable screening test for cervical cancer, so this cancer is one of the most predictable and preventable types of cancers (2). Studies showed that women face many obstacles to perform Pap smear test at standard intervals. These obstacles include lack of knowledge, religious beliefs, fatalism, fear, embarrassment and lack of trust in the interpreters (3). Common myths about cervical cancer are misconceptions about cervical cancer screening, lack of spousal support for screening, cultural taboos regarding gender of healthcare providers and stigmatization of women with cervical cancer (4). This study was conducted due to high incidence and mortality rates of cervical cancer and lack of published evidence on barriers of Pap smear testing in Kashanian postmenopausal women. This was a descriptive study conducted on 116 postmenopausal women by cluster sampling. Samples were Iranian women living in Kashan, married, sexual contact in the last year and at least one year passed from their last menstrual period. This study was approved by the ethics committee in Kashan University of Medical Sciences. All participants were assured of the privacy and confidentiality of their personal information. Data was collected using a questionnaire completed by interviews and then analyzed using descriptive statistical tests including frequencies, mean and standard deviation. The mean age of study participants was 68.0 ± 2.54 years. The mean of menopause age was 48.09 ± 4.99 years. Level of education in 57.8% of participants was under-diploma. Pap test had been performed in 65.5% of them at least one time and only 8.7% had performed it in regular intervals. Women reported that inadequate knowledge about the importance and necessity of testing (55.2%), shame (27.6%) and negligence to the health (12.9%) were the most common reasons for ignoring Pap-smear test in regular intervals. Based on the findings of this study, healthcare providers can remove the two major barriers using various educational methods such as class participation, social media and pamphlets to increase knowledge of women about the advantages of this test. Moreover, providing a private environment for test may decrease women's shame of requesting this diagnostic test.