Abstract

Background: Cervical cancer mortality in El Salvador remains a significant burden, yet participation in screening programs is variable. To improve screening participation, we sought a greater understanding of the relationship between participation and cervical cancer risk perception.
Methods: Women in rural El Salvador participating in a cervical cancer screening program responded to an administered questionnaire from 10/2012-03/2013 describing their perceived personal cancer risk and the justifications for their views. Content analyses of responses was performed to categorize the responses and Pearson’s chi-square statistics assessed associations between risk perception and justification categories.
Results: Among 409 women, 187 (45.7%) viewed themselves at risk of developing cervical cancer, 65 (15.9%) not at risk, and 157 (38.4%) uncertain. Justifications of perceived risk revealed the themes of fatalism (the concept that outcomes cannot be changed), agent causality (free will of actions that can alter outcomes), a non-exceptional view of cancer risk (all women could develop cancer), and identification of cervical cancer risk factors. Fatalistic and non-exceptional justifications were associated with a view of being at risk of developing cervical cancer (p<0.001 and p<0.0001, respectively).
Conclusion: Complex motivations and beliefs underlie cancer risk perception. Future research may allow public health programs to tailor cervical cancer education to improve screening participation.