Study pinpoints factors affecting cervical cancer screening participation in Singapore

Cervical cancer screening uptake remains suboptimal in Singapore, with uptake influenced by demographic factors, screening knowledge and awareness, health-related belief and behaviour, according to a study.

In a cohort of 665 women with an average age of 45.8 years, only 30 percent reported cervical cancer screening participation. Within a Social Ecological Model (SEM) framework, marital status was a significant predictor at the interpersonal level. Specifically, unmarried women were three times less likely to undergo screening as married women (odds ratio [OR], 0.30, 95 percent confidence interval [CI], 0.18–0.48). [Cancers (Basel) 2024;16:3475]

At the individual level, sociodemographic factors such as age and ethnicity influenced screening participation. The odds of getting screened were lower for younger women (25–29 vs 30–49 years: OR, 0.33, 95 percent CI, 0.12–0.77) and those of Malay ethnicity (OR, 0.42, 95 percent CI, 0.20–0.83).

Meanwhile, certain knowledge and awareness and beliefs and behaviours variables had a positive impact on screening participation. Good knowledge of cervical cancer screening was associated with greater odds of getting screened (OR, 2.90, 95 percent CI, 1.96–4.32), as were awareness of primary care providers’ (PCPs’) role in delivering screening services (OR, 1.94, 95 percent CI, 1.24–3.10), cancer information seeking (OR, 1.59, 95 percent CI, 1.07–2.39), and acceptance of self-sampling options (OR, 1.81, 95 percent CI, 1.22–2.70).

Hierarchical analysis synthesizing multilevel influences on screening participation showed the cumulative impact of factors at different levels of influence on cervical cancer screening participation. The investigators noted that sociodemographic and socioeconomic factors alone had a limited impact on cervical cancer screening participation, but adding knowledge, beliefs, and behaviours significantly improved the predictive power of the model.

“The progressive increase in explained variance with each added factor set underscores the complex interplay of factors affecting screening behaviour,” they said, adding that these findings demonstrate the value of the SEM framework in understanding screening behaviours and underscore the multifaceted nature of factors affecting screening participation. 

“At the individual level, we found predictors such as participants’ knowledge of cervical cancer screening, awareness on PCPs’ role in delivering screening services, cancer information-seeking behaviour, and acceptance of self-sampling options. These are all highly modifiable factors, which could inform more targeted approaches in improving screening rates,” the investigators said.

“Meanwhile, we also identified nonmodifiable predictors at both individual and interpersonal levels, such as age, Malay ethnicity, and marital status. These nonmodifiable factors offer crucial insights into tailoring strategies for specific demographic groups,” they added.

The investigators highlighted the importance of a comprehensive approach informed by the SEM to maximize the effectiveness of cervical cancer screening programs. Simultaneously targeting modifiable and nonmodifiable factors at multiple levels can enhance cervical cancer screening uptake and improve public health outcomes in Singapore, they said.