What Do Women Know About Pap Smears in Peru, and Why They Don't Get Them

Introduction: Estimates of the percentage of women who have had Pap smears in Peru varies between 7 and 30%. This study explores what women know about cervical cancer and Pap smears, as well as their barriers to obtaining Pap smears.

Methods: A total of 23 focus groups were conducted with women around 4 cities of Peru. Half of the focus groups were among women 18-25 and the other half with women aged 26-40. Also, in each city, half the focus groups were conducted in urban locations and the other half in rural areas. In Lima, the more heterogeneous capital city, all focus groups were urban, but varied by the social classes of the participants.

Results: Most women did not know what causes cervical cancer. Of the few women who provided a description of the causes, most thought it was from having miscarriages or abortions, a few mentioned it came from “strong infections” or “improper hygiene after sex”, one woman mentioned it was caused by the IUD which irritates the uterus, another mentioned that Pap smears cause it, several thought it might be genetic, and a few knew that HPV is associated with cervical cancer. Regarding Pap smears, most women did not know what they were for, although knowledge about Paps was higher than about cervical cancer. About half of the women had vaguely heard of them, and though a few thought that Paps screened for “all types of vaginal infections”, fungal infections, or ovarian cancer, most women believed Pap smears screened for cervical cancer and uterine cancer. The main barriers identified for not getting Paps were: embarrassment, fear of hearing one has cancer, lack of trust in providers, feeling healthy (and hence not needing one), lack of knowledge about what they are for, misinformation about the process of getting a sample (and hearing very scary experiences), belief that it is painful, not wanting to feel “handled” by a male provider, and because it is too costly.

Implications: Programs and policies to increase Pap smear coverage must start by educating women on cervical cancer and screening for it, and improving women's perceptions about what the process is like.