Pandeminin Görünmez Tehdidi: Kadınların Sağlık İnançlarına Göre Serviks Kanseri Tarama Değişimi

Öz

Giriş: Pandemi sürecinde gerek hastanelerin yoğunluğunu azaltmak gerekse pandeminin yayılmasını önlemek amacıyla kanser tarama programlarında değişikliklere gidilmiştir. Amaç: Kadınların COVID-19 sürecinde serviks kanseri ve pap-smear testi ile ilgili sağlık inançlarını, düşüncelerini ve uygulamalarını belirlemektir. Yöntem: Bu kesitsel çalışma, sosyal medya uygulaması üzerinden online olarak 361 kadın ile gerçekleştirilmiştir. Verilerin toplanmasında Serviks Kanseri ve Pap Smear Testi Sağlık İnanç Modeli Ölçeği kullanılmıştır. Bulgular: Kadınların %81.2’si pandemide pap smear testi yaptırmadığını ve %72.6’sı pandemi döneminde pap smear testinin ertelenmemesi gerektiğini ifade etti. Kadınların %76.7’si evde smear testini kendi kendine sürüntü alarak yapmak istemediklerini, %49.3’ü pandemide Human Papilloma Virüs aşısı yaptırabileceğini ifade etti. Serviks Kanseri ve Pap Smear Testi Sağlık İnanç Modeli Ölçeği alt boyut puan ortalamaları Pap smear yararları ve motivasyonu 15.12 ± 4.96, pap smear engelleri 40.09 ± 6.79, serviks kanseri bakımı/ciddiliği 26.21 ± 2.62, serviks kanseri duyarlılığı (12.96 ± 1.88) ve serviks kanseri sağlık motivasyonu 7.36 ± 2.37’dir. Sonuç: Kadınların pap testi algısı ve serviks kanseri duyarlılık düzeyleri yüksek bulunmasına rağmen pandemi döneminde çoğu pap smear taraması yaptırmamıştır. Bu durum serviks kanserinin önümüzdeki yıllarda görülme oranını artırabilir. Kadıların tarama programlarına katılımın devam edebilmesi için sağlık personelinin kısıtlama ve normalleşme süreçlerine göre gerekli önlemleri alması gerekmektedir.

Anahtar Kelimeler

• Serviks Kanseri
• COVID-19
• Sağlık İnanç Modeli
• Pap Smear
• Düşünce

The Invisible Threat of the Pandemic: Cervical Cancer Screening Change According to Health Belief of Women

Öz

Background: During the pandemic process, changes were made in cancer screening programs in order to reduce the density of hospitals and prevent the spread of the pandemic. Objective: To determine the health beliefs, thoughts and practices of women regarding cervical cancer and pap-smear testing during the COVID-19. Methods: The cross-sectional study was carried out with 361 women who filled out the questionnaire online through the social media application. Cervical Cancer and Pap Smear Test Health Belief Model Scale was used to collect data. Results: The women’s 81.2% stated that they did not have a pap smear test and 72.6% of them stated that the pap smear test should not be postponed during the pandemic. Their 76.7% stated that they did not want to get a self-swab smear test at home during the pandemic, 49.3% of them stated that they could get Human Papilloma Virus vaccine in the pandemic. Cervical Cancer and Pap Smear Test Health Belief Model Scale sub-dimension mean scores of Pap smear benefits and motivation (15.12 ± 4.96), pap smear barriers (40.09 ± 6.79), cervical cancer care/seriousness (26.21 ± 2.62), cervical cancer sensitivity (12.96 ± 1.88) and cervical cancer health motivation (7.36 ± 2.37). Conclusion:Although women’s perception of pap-tests and their level of cervical cancer sensitivity was found high, most of them did not have pap smear screening in the pandemic period. This may increase the incidence of cervical cancer in the future. In order for women to continue their participation in screening programs during the pandemic, health personnel should take the necessary precautions according to restriction and relaxation processes.

Anahtar Kelimeler

• Cervical Cancer
• COVID-19
• Health Belief Model
• Pap Smear
• Thought

Kaynakça

1. American Cancer Society. What are the key statistics about cervical cancer? 2020. Available from: http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics. Accesed in 2021 (June 28).
2. Aykanat Y, Demirkıran F. COVID-19 ortamında jinekolojik onkolojik girişimler [Gynecologic oncology; management in COVID-19 era]. Gökaslan H, editör. Kadın Hastalıkları ve Doğum - COVID-19. 1. Baskı. Ankara: Türkiye Klinikleri 2020;51-5.
3. Bebiş H, Reis N, Yavan T, Bayrak D, Unal A, Bodur S. (2012). Effect of health ducation about cervical cancer and papanicolaou testing on the behavior, knowledge and beliefs of Turkish women. Int J Gynecol Cancer 2012;22(8):1407-1412.
4. Carethers JM, Sengupta R, Blakey R, Ribas A, D’Souza G. Disparities in cancer prevention in the COVID-19 era. Cancer Prev Res (Phila) 2020;13(11):893-896.
5. Castanon A, Rebolj M, Burger EA, de Kok IMCM, Smith MA, Hanley SJB, et al. Cervical screening during the COVID-19 pandemic: optimising recovery strategies. Lancet Public Health 2021;6:e522–27.
6. Champion VL, Skinner CS. The health belief model. health behavior and health education: theory, research, and practice. Glanz K, Rimer BK & Viswanath K. San Francisco. Jossey-Bass. 2008.
7. Ciavattini A, Carpini GD, Giannella L, Arbyn M, Kyrgiou M, Joura EA, et al. European Federation for Colposcopy (EFC) and European Society of Gynaecological Oncology (ESGO) joint considerations about human papillomavirus (HPV) vaccination, screening programs, colposcopy, and surgery during and after the COVID-19 pandemic. Int J Gynecol Cancer 2020;30(8):1097-1100.
8. Feletto E, Grogan P, Nickson C, Smith M, Canfell K. How has COVID-19 impacted cancer screening? Adaptation of services and the future outlook in Australia. Public Health Research & Practice 2020;30(4):e3042026.

9. Gerçek Öter E, Özkan S, Çınar H. The effectiveness of using telemedicine to follow-up breast cancer during the covid-19 pandemic: A scoping review. Turk J Oncol 2022;37(1):93–99.
10. Ginsburg O, Basu P, Kapambwe S, Canfell K. Eliminating cervical cancer in the COVID-19 era. Nature Cancer 2021;2:133-134.
11. Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women’s cancers: a grand challenge in global health. Lancet 2017;389(10071):847-860.
12. Güvenç G, Akyüz A, Açıkel CH. Health belief model scale for cervical cancer and Pap smear test: psychometric testing. Journal of Advanced Nursing 2011;67(2):428–437.
13. Hawkes D, Keung MHT, Huang Y, McDermott TL, Romano J, Saville M, et al. Self-collection for cervical screening programs: from research to reality. Cancers (Basel) 2020;12:E1053.
14. Ling Woo Y, Gravitt P, Kheng Khor S, Wan Ng C, Saville M. Accelerating action on cervical screening in lower- and middle-income countries (LMICs) post COVID-19 era. Prev Med 2021;144:106294.
15. Miller MJ, Xu L, Qin J, Hahn EE, Ngo-Metzgeret Q, Mittman B, et al. Impact of COVID-19 on cervical cancer screening rates among women aged 21–65 years in a large integrated health care system — Southern California, January 1–September 30, 2019, and January 1–September 30, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(4):110-113.
16. Önal M, Katırcı Y. The impact of covid-19 on cervical cancer screenings and clinical outcomes of patients: A single-center tertiary healthcare service experience. Cumhuriyet Medical Journal 2022;44(1):92-97.
17. Öz F. Sağlık alanında temel kavramlar [Basic concepts in the field of health]. Ankara, İmaj İç ve Dış Tic. A.Ş. 2004.
18. Rohleder P. Critical issues in clinical and health psychology. London, SAGE Publications. 2012.
19. Royal College of Obstetricians & Gynaecologists (RCOG). (2020). Colposcopy guidance during COVID-19 pandemic. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-17-colposcopy-guidance-during-covid-19-pandemic.pdf Accessed in 2021 (March 16).
20. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249.
21. TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü [Republic of Turkey Ministry of Health General Directorate of Public Health]. Serviks Kanseri Tarama Programı Ulusal Standartları [Cervical Cancer Screening Program National Standards] Available from: https://hsgm.saglik.gov.tr/tr/kanser-tarama-standartlari/listesi/serviks-kanseri-tarama-program%C4%B1-ulusal-standartlar%C4%B1.html, Accessed in 2022 (November 17).
22. Türk Tabipleri Derneği. Aile Hekimliğinde Pandemi Süreci 9-15 Kasım 2020 Anketi Sonuçları [Pandemic Process in Family Medicine 9-15 November 2020 Survey Results]. Available from: https://www.ttb.org.tr/haber_goster.php?Guid=acbe0400-2b23-11eb-9fec-5d38005ac4c8. 2020. Accessed in 2021 (November 23).
23. Villain P, Carvalho AL, Lucas E, Mosquera I, Zhang L, Muwonge R, et al. Cross-sectional survey of the impact of the COVID-19 pandemic on cancer screening programs in selected low- and middle-income countries: Study from the IARC COVID-19 impact study group. Int J Cancer 2021;149(1):97-107.