Main Organiser

Julius Centre University of Malaya


Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya



YL Wong, K Chinna, LP Wong & J Mariapun


Julius Centre University of Malaya (JCUM), Social & Preventive Medicine, Faculty of Medicine, University of Malaya


Objectives: Knowledge of risk factors of cervical cancer is associated with the uptake of Pap smear test. The 1996 Second National Morbidity Survey reported only 26% of women had undergone screening in Malaysia, despite implementation of the national Pap smear screening program since 1969. A multi-site study was conducted to identify the correlates between risk perceptions and cervical cancer screening.

Methods: Mixed methods were applied. In-depth qualitative interviews were conducted to explore the level of knowledge, understanding and beliefs of cervical cancer and screening among women (N=60). Following this, a cross-sectional household survey was implemented using strata sampling provided by the Department of Statistics Malaysia (N=450).

Results: The women had limited knowledge about established risks for cervical cancer. Majority perceived certain types of food (instant noodles or chemical substances embedded in foods); smoking; drugs taking; family history; side effects of HRT; adultery; cleanliness of both husband and wife; environmental or air pollution and use of public toilets, poor feminine hygiene, contraceptive use, unclean abortion, frequent sex and sexual activities against the norm of religion as risks for cervical cancer. Awareness and knowledge of HPV were very limited. The practice of Pap smear screening is not regular or sustained. Instead, it was opportunistic screening during pre or postnatal care. Once they ceased giving birth, women also stopped Pap smear screening. In the household survey, 55.8% of the respondents had Pap smear test at least once. Among the variables tested, only Age (OR = 1.08, 95% CI = 1.14, 1.13), knowledge of signs & symptoms (OR=1.64; 95% CI=1.11, 2.42), number of pregnancies (OR=1.36; 95% CI=1.2, 1.54), education level and religion were found to be significantly correlated with Pap smear screening. Those with primary education (10%) and with certificate (14%) were less likely to uptake screening. Also it was found that the Muslim women were less likely to uptake screening (40%).

Conclusions: Thus, emphasis should be placed on the understanding of cervical cancer etiology and the causative role of HPV to eliminate anecdotal beliefs as risks for cervical cancer. Expanding the knowledge of risk factors of cervical cancer is strategic for increasing and sustaining uptake of Pap smear screening versus current opportunistic screening practices.