EC Microbiology

Objectives: To evaluate the knowledge of urban adult Lebanese women regarding the symptoms and risk factors of cervical cancer and the diagnostic tests and vaccination of human papillomavirus (HPV) infection. To measure in the same population the uptake of the cervical cancer-screening test (Pap smear) and the uptake of HPV vaccination, and determine the factors that may influence them.

Methods: 444 Lebanese women above 18 years of age, residing in Beirut and Mount-Lebanon, with no medical background, were recruited online and in health care facilities to fill out a 32 item questionnaire about cervical cancer and HPV. Collected data was exported to and analyzed in SPSS^® v. 21.0.

Results: 45.7% of the women aged 18 to 25 y, residing in Mount-Lebanon (51.8%), single (49.3%), with high education qualifications (73.9%) and currently employed (49.1%) in a field not related to health (84.9%). They did not visit a general physician (64%) or a gynecologist (64.6%) regularly. 85.6% were aware of cervical cancer; HPV infection involvement in the pathogenesis of cervical cancer was identified in 53.9% of cases. 35.6% of women were aware of HPV infection but 80.4% believed they lack information. 37.6% of participants had been screened by Pap smear for cervical cancer at least once whereas 9% did not know what a Pap smear was. Screening was significantly associated with cervical cancer awareness and regular visits to general health physicians and gynecologists. Only 11.7% of participants aged 18 to 35 were vaccinated against HPV. Vaccination uptake was significantly associated with cervical cancer awareness, religion, field of work and studies, and regular visits to gynecologists.

Conclusion: Urban Lebanese women in Beirut and Mount-Lebanon are not well informed about cervical cancer and HPV. Screening by Pap smear and HPV vaccination uptakes are non-satisfactory. Further interventions are required to improve these numbers.

Keywords: Cervical Cancer (CC); Human Papillomavirus (HPV); Pap Smear

1. Fact Sheets by Cancer (2015).
2. Seoud M. “Extended Middle East and North Africa: cervical cancer and human papillomavirus: can we make the case for prevention in this “relatively” low prevalence region?” Vaccine6 (2013): vii-viii.
3. Sancho-Garnier H., et al. “Overview of cervical cancer screening practices in the extended Middle East and North Africa countries”. Vaccine6 (2013): G51-57.
4. Sakr R and Adib S. “Knowledge, perceptions and practices concerning pap smear screening for cervical cancer in Lebanon (2015).
5. Reichman RC. Chapter 185. Human Papillomavirus Infections. Harrison’s Principles of Internal Medicine. 18^th McGraw-Hill (2021).
6. Bosch FX., et al. “Comprehensive control of human papillomavirus infections and related diseases”. Vaccine7 (2013): H1-31.
7. Schiller JT., et al. “A review of clinical trials of human papillomavirus prophylactic vaccines”. Vaccine5 (2012): F123-138.
8. El-Kak F. “Sexuality and sexual health: constructs and expressions in the extended Middle East and North Africa”. Vaccine6 (2013): G45-50.
9. Fisher WA. “Understanding human papillomavirus vaccine uptake”. Vaccine5 (2012): F149-F156.
10. The EVE Appeal. What Women Know – Report on Awareness Levels of Cervical Cancer amongst Women in England (2022).
11. Blake KD., et al. “Predictors of Human Papillomavirus Awareness and Knowledge in 2013: Gaps and Opportunities for Targeted Communication Strategies”. The American College of Preventive Medicine (2015).
12. Ebu NI., et al. “Knowledge, practice, and barriers toward cervical cancer screening in Elmina, Southern Ghana”. International Journal of Women's Health 7 (2015): 31-39.
13. Df (2008).
14. Ali SF., et al. “Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in Tertiary Care Hospitals in Karachi, Pakistan”. PloS One6 (2010): e11059.
15. Sait KH. “Knowledge, attitudes, and practices regarding cervical cancer screening among physicians in the Western Region of Saudi Arabia”. Saudi Medical Journal11 (2011): 1155-1160.
16. Rama CH., et al. “Awareness and knowledge of HPV, cervical cancer, and vaccines in young women after first delivery in São Paulo, Brazil - a cross-sectional study”. BMC Women's Health1 (2010): 35.
17. Dodd RH., et al. “Knowledge of human papillomavirus (HPV) testing in the USA, the UK and Australia: an international survey”. Sexually Transmitted Infections (2014).
18. Marlow LAV., et al. “Ethnic differences in human papillomavirus awareness and vaccine acceptability”. Journal of Epidemiology and Community Health12 (2009): 1010-1015.
19. Dany M., et al. “Human papillomavirus vaccination: Assessing knowledge, attitudes, and intentions of college female students in Lebanon, a developing country”. Vaccine (2015).
20. Jena AB., et al. “Incidence of Sexually Transmitted Infections After Human Papillomavirus Vaccination Among Adolescent Females”. JAMA Internal Medicine (2015).