Knowledge and attitudes of women regarding gynaecological cancer prevention in an urban area of Greece in financial crisis

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Preventive gynaecological examinations (PGEs) are a key management tool for the prevention of gynaecological cancers in all developed health systems, and many awareness programmes that focus on the female population have been activated worldwide 1. But if we want these programmes to yield positive results, we should first change the perceptions, attitudes and factors that keep the target group shying away from screening tests 3.
Recent studies have shown that there are social factors that combined with genetic, biological and environmental factors favour the occurrence of severe diseases such as breast and cervical cancer 6. However, it has been argued that financial crises should be included among the negative factors that may have a negative impact on women's health 8.
Social factors associated with poverty, culture and social injustice are the main causes of health inequalities. All these factors have consolidated knowledge, attitudes and behaviours that may stop women from screening examinations 10. Barriers related to poverty are lack of primary healthcare centres, inadequate health insurance and limited access to health care. Barriers related to culture include beliefs, cultural reasons and a general distrust of the health care system, and barriers related to social injustice include gender stereotypes and discrimination 11. Many of these barriers are potentially modifiable. Thus, knowledge of women's perceptions about the usefulness of preventive gynaecological examinations will form the basis on which the screening programme will be designed, according to a study by the International Institute for Cancer Research 13.
Perceptions and attitudes of women have already been studied, and the results of these studies have been published in several countries and at a similar rate in Greece too 14, but also in countries with more advanced health systems 15. It is obvious that if a health system wants to develop a screening programme, it is essential to explore women's perception of the disease. Women have significant knowledge deficits related to HPV, cervical cancer prevention and regarding HPV vaccination, even after repeated visits for management of abnormal Pap tests and cervical cancer precursors. This may be because underlying educational deficits are a barrier to understanding cancer prevention messages 16. Gynaecological cancer is a disease which may be prevented and cured in case of early diagnosis. Nevertheless, studies performed indicate that owing to lots of factors such as lack of education, lack of knowledge about scanning, economical problems, the problems of attaining health services, the fear of having pain, the embarrassment and the false beliefs, women do not take the advantage of early diagnosis 17. The available studies on the Greek financial crisis and its impact on the prevention of diseases in relation to women's health are relatively low, compared to similar studies from around the world and those studies mainly deal with the economic crisis as a problem with economic dimensions and minimum social repercussions 18.
Human papillomavirus (HPV) knowledge and awareness in many countries, especially in developing countries, is still low 20. The results of recent Greek studies regarding perceptions and attitudes of women for HPV and HPV vaccinations generally show a tendency to doubt the vaccine and neglect condom use, since only 50% of women refer regularly using it. Therefore, there is a difference between beliefs about HPV vaccine, condom use and their attitudes 21. Knowledge level about HPV prevention is also very low in some Arabic and Asian countries 24, but in some other countries is high enough 17.
The consequence of the women's abstention from preventive gynaecological examinations is the increasing mortality from breast and cervical cancer.

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