Knowledge, Attitudes, And Practices Regarding Cervical Cancer Awareness And Prevention In Southern Eastern Europe: A Narrative Review

Abstract

This narrative review examines the knowledge, attitudes, and practices (KAP) related to cervical cancer across Southeastern Europe, with a focus on disparities in awareness, prevention efforts, and healthcare access. A comprehensive search of PubMed over the past 12 years was conducted to assess gaps in KAP regarding cervical cancer and human papillomavirus (HPV) prevention. The findings revealed significant gaps in KAP, including limited knowledge about cervical cancer risk factors, inadequate attitudes toward screening, and poor preventive practices, such as low participation in screening programs and HPV vaccine uptake. Economic challenges and inconsistent healthcare communication further hinder progress. The review emphasizes the need for targeted public health strategies, focusing on improving education, social mobilization, and access to essential services. Further research is necessary to address sociocultural and economic factors contributing to these gaps and to develop tailored interventions suited to the region's diverse populations.

Keywords:

Cervical Cancer, HPV Vaccination, KAP (Knowledge, Attitudes, Practices), HPV Screening, Southeastern Europe

References

Fowler JR, Maani EV, Dunton CJ, Gasalberti DP, Jack BW. Cervical Cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Sep 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK431093/

Population of Southern Europe (2024) - Worldometer [Internet]. [cited 2024 Sep 20]. Available from: https://www.worldometers.info/world-population/southern-europe-population/

Vrdoljak E, Wojtukiewicz MZ, Pienkowski T, Bodoky G, Berzinec P, Finek J, et al. Cancer epidemiology in Central and South Eastern European countries. Croat Med J. 2011 Aug;52(4):478–87.

Andrade C, Menon V, Ameen S, Kumar Praharaj S. Designing and Conducting Knowledge, Attitude, and Practice Surveys in Psychiatry: Practical Guidance. Indian J Psychol Med. 2020 Aug 27;42(5):478–81.

Bruni L, Albero G, Serrano B, Mena M, Collado JJ, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 10 March 2023.

Rechel B, Schwalbe N, McKee M. Health in south-eastern Europe: a troubled past, an uncertain future. Bull World Health Organ. 2004 Jul;82(7):539–46.

Arbyn M, Raifu AO, Weiderpass E, Bray F, Anttila A. Trends of cervical cancer mortality in the member states of the European Union. Eur J Cancer. 2009 Oct 1;45(15):2640–8.

Todor RD, Bratucu G, Moga MA, Candrea AN, Marceanu LG, Anastasiu CV. Challenges in the Prevention of Cervical Cancer in Romania. Int J Environ Res Public Health. 2021 Feb;18(4):1721.

Voidăzan S, Tarcea M, Morariu SH, Grigore A, Dobreanu M. Human Papillomavirus Vaccine - Knowledge and Attitudes among Parents of Children Aged 10-14 Years: a Cross-sectional Study, Tîrgu Mureş, Romania. Cent Eur J Public Health. 2016 Mar;24(1):29–38.

Voidăzan TS, Budianu MA, Rozsnyai FF, Kovacs Z, Uzun CC, Neagu N. Assessing the Level of Knowledge, Beliefs and Acceptance of HPV Vaccine: A Cross-Sectional Study in Romania. Int J Environ Res Public Health. 2022 Jun 6;19(11):6939.

Grigore: Awareness and knowledge about HPV and HPV... - Google Scholar [Internet]. [cited 2024 Sep 21]. Available from: https://scholar.google.com/scholar_lookup?journal=J.+Cancer+Educ.&title=Awareness+and+Knowledge+About+HPV+and+HPV+Vaccine+Among+Romanian+Women&author=M.+Grigore&author=S.I.+Teleman&author=A.+Pristavu&author=M.+Matei&volume=33&publication_year=2016&pages=154-159&doi=10.1007/s13187-016-1130-2&

Jackowska M, von Wagner C, Wardle J, Juszczyk D, Luszczynska A, Waller J. Cervical screening among migrant women: a qualitative study of Polish, Slovak and Romanian women in London, UK. J Fam Plann Reprod Health Care. 2012 Oct;38(4):229–38.

Pergialiotis V, Papageorgiou D, Douligeris A, Mortaki A, Vlachos DE, Thomakos N, et al. Awareness, knowledge and attitudes of human papillomavirus infection, screening and vaccination: a survey study in Greece. Arch Gynecol Obstet. 2024 May;309(5):2031–40.

Sidiropoulou M, Gerogianni G, Kourti FE, Pappa D, Zartaloudi A, Koutelekos I, et al. Perceptions, Knowledge and Attitudes among Young Adults about Prevention of HPV Infection and Immunization. Healthc Basel Switz. 2022 Sep 8;10(9):1721.

Riza E, Karakosta A, Tsiampalis T, Lazarou D, Karachaliou A, Ntelis S, et al. Knowledge, Attitudes and Perceptions about Cervical Cancer Risk, Prevention and Human Papilloma Virus (HPV) in Vulnerable Women in Greece. Int J Environ Res Public Health. 2020 Sep 21;17(18):6892.

Thanasas I, Lavranos G, Gkogkou P, Paraskevis D. The Effect of Health Education on Adolescents’ Awareness of HPV Infections and Attitudes towards HPV Vaccination in Greece. Int J Environ Res Public Health. 2022 Jan 3;19(1):503.

Siamanta V, Chatzistamatiou K, Vavilis D, Nena E, Chatzaki Ε, Constantinidis TC, et al. Personal and parental acceptance of human papillomavirus vaccination prior to and during the economic crisis among women in Greece. J BUON Off J Balk Union Oncol. 2018 Dec;23(7):34–43.

Antic LG, Djikanovic BS, Antic DZ, Aleksopulos HG, Trajkovic GZ. Differences in the level of knowledge on cervical cancer among health care students, midwives and patients in Serbia. Asian Pac J Cancer Prev APJCP. 2014;15(7):3011–5.

Naumovic T, Jovanovic V, Ilic D, Rakic U, Mirkov D, Perisic Z. Performance indicators collected from primary health centres included in organised cervical cancer screening programme in the Republic of Serbia. J BUON Off J Balk Union Oncol. 2015;20(3):842–6.

Markovic-Denic L, Milicevic S, Todorovic J, Nikolic V, Djuric O, Marusic V, et al. Uptake of Human Papillomavirus Vaccine and Intention to Vaccinate among Healthy Pregnant Women in Serbia: A Cross-Sectional Study on Awareness, Knowledge, and Attitudes. Viruses. 2021 Apr 21;13(5):727.

Tomić SD, Ćorić A, Tomić S, Mujičić E, Malenković J, Šljivo A, et al. Cervical Cancer Prevention Knowledge (Cckp-64) among Female Students in Novi Sad, Serbia during COVID-19 Pandemic. Healthc Basel Switz. 2023 May 12;11(10):1400.

Štrbac M, Vuković V, Pustahija T, Nikolić N, Rajčević S, Ilić S, et al. Motives and attitudes of parents toward HPV vaccination: Results from the initial period of HPV vaccine rollout in Serbia. PloS One. 2023;18(7):e0287295.

Merkuri L, Kamberi F, Qorri E, Shapo L. Assessment of the Albanian University female students’ knowledge, attitudes, and practices on cervical cancer. J Infect Dev Ctries. 2023 Apr 30;17(4):534–41.

Review IJ of R and. Brachytherapy’s Clinical-Imagery Correlates and Tumor’s Reduction Outputs Among Patients with Cervical Cancer. Int J Res Rev [Internet]. 2022 [cited 2024 Sep 21];9(11). Available from: https://www.ijrrjournal.com/IJRR_Vol.9_Issue.11_Nov2022/IJRR-Abstract66.html

Ylli A, Filipi K, Shundi L, Fico A, Risto M, Xhani A. New cervical screening program in Albania. Access and barriers in all levels of health system. Eur J Public Health. 2020 Sep 1;30(Supplement_5):ckaa166.487.

Raçi PZ, Raçi F, Hadri T. Kosovo women’s knowledge and awareness of human papillomavirus (HPV) infection, HPV vaccination, and its relation to cervical cancer. BMC Womens Health. 2021 Oct 9;21(1):354.

Robles C, Bruni L, Acera A, Riera JC, Prats L, Poljak M, et al. Determinants of Human Papillomavirus Vaccine Uptake by Adult Women Attending Cervical Cancer Screening in 9 European Countries. Am J Prev Med. 2021 Apr;60(4):478–87.

Zdravstveni statistični letopis 2016 [Internet]. Nijz. [cited 2024 Sep 21]. Available from: https://nijz.si/publikacije/zdravstveni-statisticni-letopis-2016/

New study reveals Europe’s patchwork of policies on cervical cancer prevention is failing women who need it most | EPF [Internet]. [cited 2024 Sep 21]. Available from: https://www.epfweb.org/node/504