Abstract
The number of hospital visits with cervical cancer as the chief complaint among South Korean women aged 20 to 39 has increased by 1.2 times between 2016 and 2020, indicating a need for active screening for the disease. This study aimed to investigate the status of the Papanicolaou (Pap) test and identify factors influencing Pap test experience among South Korean women aged 20 to 39 years. An online questionnaire survey was conducted over 5 days starting from November 19, 2021. A total of 338 participants who were randomly sampled by age completed the survey. Data were analyzed using descriptive statistics, t test, χ2 test, and logistic regression. The mean age of the participants was 29.9 years, and participants with and without Pap test experience accounted for 60.7% and 39.3% of the total, respectively. There were significant differences in age, marital status, employment status, smoking status, experience of coitus, awareness of the National Cancer Screening Program, and human papillomavirus (HPV) vaccination status according to the Pap test experience (P < .05) of the participants. Pap test attitude, Pap test self-efficacy, cervical cancer knowledge, HPV knowledge, and cancer prevention behavior scores were significantly higher in the Pap test experience group than in the no Pap test experience group (P < .05). Logistic regression analysis showed that experience of coitus (odds ratio [OR] = 10.46, 95% confidence interval [CI]: 4.54–24.11), marital status (OR = 5.96, 95% CI: 2.25–15.77), awareness of the National Cancer Screening Program (OR = 4.39, 95% CI: 1.66–11.58), HPV vaccination (OR = 2.62, 95% CI: 1.35–5.09), employment status (OR = 2.22, 95% CI: 1.08–4.59), and self-efficacy (OR = 1.09, 95% CI: 1.01–1.19) were the influencing factors in the Pap test experience group. To improve the Pap test screening rate among South Korean women aged 20 to 39, reinforcement strategies and intervention programs that involve age-specific approaches must be established.
Keywords: cancer screening test, cervical cancer, knowledge, Pap test, self-efficacy, women
1. Introduction
The number of hospital visits with cervical cancer (CC) as the chief complaint among South Korean women aged 20 to 39 years has increased by 1.2 times between 2016 and 2020, from 14,572 to 17,806.[1] The primary cause of CC is human papillomavirus (HPV) infection,[2] and the number of patients with condyloma acuminata caused by the same virus has also increased by 1.1 times among women aged 20 to 39 years during the same period.[3] These findings indicate the need for more intensive CC preventive care for South Korean women aged 20 to 39 years.
Since CC can be treated if detected early by the Papanicolaou (Pap) test, regular screening can drastically reduce the risk of invasive cancer.[4] In South Korea, since 2016, Pap tests have been performed every 2 years on women aged ≥ 20 years as a part of the National Cancer Screening Program (NCSP) for CC prevention. In addition, since 2016, the Korea Disease Control and Prevention Agency has been providing free HPV vaccination to girls aged 12 years for CC prevention.
However, many women do not undergo Pap testing. The Pap test screening rate among South Korean women was 58.7% in 2019, which was lower than the screening rate for liver cancer (73.5%) and breast cancer (64.8%), as well as lower than the screening rates in the US (78.5%) and UK (71.4%). In particular, the screening rate among women aged 20 to 39 years was 54.0% in 2019, which represented a significant increase from 41.6% in 2016 when the screening age of women was expanded to ≥ 20 years, although it is still lower than the average screening rate in South Korea and other countries.[5,6] In addition to feeling embarrassment and fear about the Pap test procedure,[7] lack of knowledge/awareness, sociocultural prejudice against gynecological examination, and a negative attitude such as feelings of shame can act as barriers to the screening in young women.[8–11]
Considering that most patients with sexually transmitted diseases in South Korea are young people and that the average age of the first sexual experience has gradually decreased to 13.6 years, efforts to prevent CC among young women are essential.[12,13] Above all, management through regular screening is critical for CC prevention. Therefore, this study focused on young adult women.
This study aimed to survey the Pap test experience among women aged 20 to 39 years, investigate the influencing factors, and provide evidence-based data to raise awareness and encourage regular Pap screening as a means of preventing CC, especially among women in their 20s and 30s who are experiencing the NCSP for the first time.
2. Methods
2.1. Study design
This was a descriptive survey study investigating the status of Pap test screening and identifying the factors influencing the Pap test experience among women aged 20 to 39 years.
2.2. Ethics approval and consent to participate
This study was performed in line with the principles of the Declaration of Helsinki. The study was conducted after obtaining approval from the Institutional Review Board (IRB; JJNU-IRB-2021-078) for the objective and methods of the study, confidentiality, data management, study information sheet, consent form, and questionnaire. Informed consent was obtained from all the participants.
2.3. Participants and data collection
Macromill Embrain Co., an online research firm, was hired for data collection, which was performed over 5 days starting from November 19, 2021. The sample size was calculated using G*power 3.1.9.4 program (Universität Düsseldorf, Düsseldorf, Germany). When the parameters for binomial logistic regression analysis were set to 2 tails, odds ratio (OR) = 1.5, significance level (α) = 0.05, and statistical power (1-β) = 0.9, the minimum sample size required was 275. The email addresses of a panel of women aged 20 to 39 years who are registered with the online research firm were extracted using equal allocation by age. A request to participate in the survey was sent to the addresses, and ultimately 338 participants completed the survey. The system used for the survey was set up to close if the response time was too short or some responses were missing. Women who did not consent to participate or dropped out during the survey were excluded.
2.4. Study tools
2.4.1. Sociodemographic characteristics
Age, marital status, education status, employment status, smoking status, experience of coitus, family history of CC, Pap test experience, awareness of the NCSP, and HPV vaccination status were investigated.
2.4.2. Attitude toward the Pap test
This refers to the subjective awareness of the benefits of undergoing a Pap test and the consequences and barriers to not receiving one. In this study, a tool developed by Jo (unpublished dissertation) was used to measure the attitude toward the Pap test. The tool consists of 14 items, each rated on a 4-point Likert scale from “Not at all” to “Very much so.” The total score ranged between 14 and 56 points, with higher scores indicating a more positive Pap test attitude. The tool’s reliability was Cronbach α = 0.88 at the time of development and Cronbach α = 0.86 in this study.
2.4.3. Pap test self-efficacy
The tool developed by Jo (unpublished dissertation) for measuring Pap test-related self-efficacy of women was used. The tool consists of 10 items, each rated on a 4-point Likert scale from “Not at all” to “Very much so.” The total score ranged between 10 and 40 points, with higher scores indicating higher self-efficacy for screening behavior. The tool’s reliability was Cronbach α = 0.93 at the time of development and Cronbach α = 0.90 in this study.
2.4.4. Knowledge of CC
This study used a tool developed by Kim and Park[14] for measuring CC knowledge among female university students. The tool consists of 8 items, each answered as “Yes,” “No,” or “Not sure.” Each correct answer was assigned 1 point, while a wrong or no answer was assigned 0 points. The total score ranged between 0 and 8 points, with higher scores indicating higher CC knowledge. The tool’s reliability was Cronbach α = 0.83 at the time of development and Cronbach α = 0.57 in this study.
2.4.5. Knowledge of HPV
This study used a tool developed by Kim and Ahn[15] for measuring HPV knowledge. The tool consists of 20 items, each answered as “Yes,” “No,” or “Not sure.” Each correct answer was assigned 1 point, while a wrong or no answer was assigned 0 points. The total score ranged between 0 and 20 points, with higher scores indicating higher HPV knowledge. The tool’s reliability was Cronbach α = 0.87 at the time of development and Cronbach α = 0.88 in this study.
2.4.6. Cancer prevention behavior
To identify the level of general cancer prevention practice, participants were instructed to check the items they practice among the 10 national cancer prevention practice rules presented by the National Cancer Information Center.[16] Each “Yes” response was assigned 1 point, and a “No” response was assigned 0 points. The total score ranged between 0 and 10 points, with higher scores indicating better cancer prevention behavior. The tool’s reliability was Cronbach α = 0.73 in a previous study[17] and Cronbach α = 0.70 in this study.
2.5. Statistical analyses
Collected data were analyzed using the SPSS 23.0/PC program (IBM Corp., Armonk, NY). Descriptive statistics were used to present the sociodemographic characteristics, Pap test attitude, Pap test self-efficacy, CC knowledge, HPV knowledge, and cancer prevention behavior. Chi-square and t tests were performed to compare the differences in sociodemographic characteristics, Pap test attitude, Pap test self-efficacy, CC knowledge, HPV knowledge, and cancer prevention behavior according to the Pap test experience of the participants. Binomial logistic regression analysis was performed to investigate the influencing factors according to the Pap test experience of the participants.
3. Results
3.1. Sociodemographic characteristics
According to the age distribution, there were 165 (48.8%) and 173 participants (51.2%) aged 20 to 29 and 30 to 39 years, respectively, with a mean age of 29.9 ± 5.1 years. The number of married and unmarried participants was 107 (31.7%) and 231 (68.3%), respectively. With respect to education level, most participants (n = 198, 58.6%) were university graduates. Meanwhile, 227 participants (67.2%) were employed, and 111 (32.8%) were unemployed. There were 63 smokers (18.6%). In addition, 256 participants (75.7%) had coitus experience, with the mean age of first coitus being 22.16 ± 3.89 years (min: 15, max: 36 years). The group with Pap test experience (PT group) consisted of 205 participants (60.7%), while the group with no Pap test experience (non-PT group) consisted of 133 participants (29.3%). Furthermore, 21 participants (6.2%) had a family history of CC, 293 (86.7%) were aware of the NCSP, and 129 (38.2%) had received HPV vaccination (Table 1).
Table 1.
Differences in characteristics according to Pap test experience (N = 338).
| Variables | Categories | Total | Experience with Pap test | χ2 (p) or t (p) | |
|---|---|---|---|---|---|
| Yes (n = 205) | No (n = 133) | ||||
| n (%) or M ± SD | |||||
| Age (yr) | 20–29 | 165 (48.8) | 72 (35.1) | 93 (69.9) | 39.10 (<.001) |
| 30–39 | 173 (51.2) | 133 (64.9) | 40 (30.1) | ||
| Marital status | Yes | 107 (31.7) | 97 (47.3) | 10 (7.5) | 59.06 (<.001) |
| No | 231 (68.3) | 108 (52.7) | 123 (92.5) | ||
| Education status | ≤High school | 37 (10.9) | 17 (8.3) | 20 (15.0) | 3.80 (.283) |
| College | 75 (22.2) | 47 (22.9) | 28 (21.1) | ||
| University | 198 (58.6) | 124 (60.5) | 74 (55.6) | ||
| ≥Graduate school | 28 (8.3) | 17 (8.3) | 11 (8.3) | ||
| Employment status | Employed | 227 (67.2) | 155 (75.6) | 72 (54.1) | 16.87 (<.001) |
| Unemployed | 111 (32.8) | 50 (24.4) | 61 (45.9) | ||
| Smoking status | nonsmoker | 275 (81.4) | 159 (77.6) | 116 (87.2) | 4.96 (.026) |
| Smoker | 63 (18.6) | 46 (22.4) | 17 (12.8) | ||
| Experience of coitus | Yes | 256 (75.7) | 195 (95.1) | 61 (45.9) | 106.52 (<.001) |
| Age of first coitus (n = 256) | 22.16 ± 3.89 | 22.36 ± 4.14 | 21.51 ± 2.88 | ||
| No | 82 (24.3) | 10 (4.9) | 72 (54.1) | ||
| Family history of CC | Yes | 21 (6.2) | 12 (5.9) | 9 (6.8) | 0.12 (.734) |
| No | 317 (93.8) | 193 (94.1) | 124 (93.2) | ||
| Awareness of the NCSP | Yes | 293 (86.7) | 196 (95.6) | 97 (72.9) | 35.94 (<.001) |
| No | 45 (13.3) | 9 (4.4) | 36 (27.1) | ||
| HPV vaccination | Yes | 129 (38.2) | 94 (45.9) | 35 (26.3) | 13.05 (<.001) |
| No | 209 (61.8) | 111 (54.1) | 98 (73.7) | ||
| Attitude toward the Pap test | 44.20 ± 5.42 | 45.18 ± 5.44 | 42.69 ± 5.04 | 4.23 (<.001) | |
| Pap test self-efficacy | 29.09 ± 4.69 | 30.09 ± 4.68 | 27.54 ± 4.29 | 5.06 (<.001) | |
| Knowledge of CC | 3.49 ± 1.67 | 3.73 ± 1.67 | 3.12 ± 1.62 | 3.33 (.001) | |
| Knowledge of HPV | 5.21 ± 3.18 | 5.50 ± 3.19 | 4.77 ± 3.12 | 2.09 (.038) | |
| Cancer prevention behavior | 7.55 ± 2.10 | 7.76 ± 2.02 | 7.24 ± 2.20 | 2.22 (.027) | |
CC = cervical cancer, HPV = human papillomavirus, NCSP = National Cancer Screening Program.
3.2. Level of Pap test attitude, Pap test self-efficacy, CC knowledge, HPV knowledge, and cancer prevention behavior
The mean scores, as measured by the tools described above, were as follows: Pap test attitude = 44.20 ± 5.42 points; Pap test self-efficacy = 29.09 ± 4.69 points; CC knowledge = 3.49 ± 1.67 points; HPV knowledge = 5.21 ± 3.18 points; and cancer prevention behavior = 7.55 ± 2.10 points (Table 1).
3.3. Differences in characteristics according to Pap test experience
Differences in characteristics according to the Pap test experience of the participants were investigated. Among the sociodemographic characteristics, age (P < .001), marital status (P < .001), employment status (P < .001), smoking status (P = .026), experience of coitus (P < .001), awareness of the NCSP (P < .001), and HPV vaccination (P < .001) showed significant differences according to the Pap test experience. Furthermore, Pap test attitude (P < .001), Pap test self-efficacy (P < .001), CC knowledge (P = .001), HPV knowledge (P = .038), and cancer prevention behavior (P = .027) all showed significant differences according to the Pap test experience (Table 1).
3.4. Factors influencing Pap test experience
To identify the factors influencing Pap test experience, binomial logistic regression was performed with factors that showed a significant difference in univariate analysis (sociodemographic characteristics [age, marital status, employment status, smoking status, experience of coitus, awareness of the NCSP, and HPV vaccination], Pap test attitude, Pap test self-efficacy, CC knowledge, HPV knowledge, and cancer prevention behavior) as the independent variables and Pap test experience as the dependent variable.
The regression model used was significant (χ2 = 182.90, P < .001), and the explanatory power was 56.6% based on the Nagelkerke determination coefficient. Classification accuracy was 81.7%. The model in the present study was determined to fit the data analyzed herein since the hypothesis that this model would show no difference between the measured and predicted values could not be rejected based on the Hosmer–Lemeshow test results (χ2 = 5.30, P = .725).
The identified significant factors influencing Pap test experience were marital status, employment status, experience of coitus, awareness of the NCSP, HPV vaccination, and Pap test self-efficacy. Married individuals had a 5.96 times higher OR of having a Pap test compared to unmarried individuals. The odds were 2.22 and 10.46 times higher for employed and individuals with coitus experience, compared to unemployed individuals and individuals without coitus experience, respectively. The odds were 4.39 times higher for individuals aware of the NCSP and 2.62 times higher for individuals who received HPV vaccination, compared to those who were not aware and those who did not receive the vaccination, respectively. Concerning the Pap test self-efficacy, an increase of 1 point was associated with an increase of 1.09 times in the likelihood of Pap test experience (Table 2).
Table 2.
Factors affecting Pap test experience among South Korean women (20–39 years) by binary logistic regression (N = 338).
| Variables | B | SE | OR | (95% CI) | P value |
|---|---|---|---|---|---|
| Age (yr) | 0.014 | 0.04 | 1.01 | 0.94–1.10 | .729 |
| Marital status (Ref. = No) | 1.786 | 0.50 | 5.96 | 2.25–15.77 | <.001 |
| Employment status (Ref. = Unemployed) | 0.799 | 0.37 | 2.22 | 1.08–4.59 | .031 |
| Smoking status (Ref. = non-smoker) | 0.383 | 0.42 | 1.47 | 0.65–3.31 | .357 |
| Experience of coitus (Ref. = No) | 2.348 | 0.43 | 10.46 | 4.54–24.11 | <.001 |
| Awareness of the NCSP (Ref. = No) | 1.478 | 0.50 | 4.39 | 1.66–11.58 | .003 |
| HPV vaccination (Ref. = No) | 0.962 | 0.34 | 2.62 | 1.35–5.09 | .005 |
| Attitude toward the Pap test | 0.012 | 0.04 | 1.01 | 0.94–1.08 | .732 |
| Pap test self-efficacy | 0.086 | 0.04 | 1.09 | 1.01–1.19 | .046 |
| Knowledge of CC | 0.095 | 0.11 | 1.10 | 0.88–1.37 | .407 |
| Knowledge of HPV | 0.068 | 0.06 | 1.07 | 0.95–1.20 | .257 |
| Cancer prevention behavior | -0.008 | 0.08 | 0.99 | 0.85–1.15 | .914 |
CC = cervical cancer, CI = confidence interval, HPV = human papillomavirus, NCSP = National Cancer Screening Program, OR = odds ratio, Pap = Papanicolaou, SE = standard error.
4. Discussion
Intending to provide basic data for the development of educational programs to increase the CC screening rate, this study investigated the status of the Pap test and analyzed the factors affecting the Pap test experience among women aged 20 to 39 years.
The Pap test screening rate among the participants was 60.7%, which was higher than 54.0% for South Korean women aged 20 to 39 years and 58.7% for South Korean women of all ages reported in 2019,[6] confirming increased participation in Pap testing. It could also be inferred that South Korean woman had more awareness and a more positive attitude toward the Pap test. However, upon investigating whether the participants were aware that the NCSP was providing free Pap tests to women aged ≥ 20 years once every 2 years, 13.3% of the participants were found to be unaware of this information. This rate was notably lower than the 41.7% found in a study on university students,[18] suggesting that the NCSP is being implemented successfully by the South Korean government to reduce the incidence of CC.[19,20] However, because > 10% of participants were unaware of the NCSP, continued efforts are needed to prevent such women from missing the opportunity for CC prevention owing to being unaware of available information. Young women in South Korea usually prefer practical and realistic messages regarding CC and HPV vaccination, including messages that include both men and women and campaigns with high accessibility and exposure.[11] To raise awareness about Pap testing, it is necessary to implement customized interventions and to identify barriers in different age groups.[10]
The Pap test attitude and self-efficacy scores of the participants were similar to those in a previous study.[18] The cancer prevention behavior score was also similar to that reported in another study.[17] The CC knowledge score showed no significant difference when compared with the score in a study on some female university students,[14] but was lower than the score in a study on nursing students.[18] The HPV knowledge score was lower than that in a study on nurses[9] and female university students (nursing students accounting for 53.7%).[15] These differences could be attributed to the differences in the study population since the present study randomly sampled women aged 20 to 39 years from a nationwide panel.
Among the sociodemographic characteristics, age, marital status, employment status, smoking status, experience of coitus, awareness of the NCSP, and HPV vaccination showed differences according to the Pap test experience. Moreover, Pap test attitude and self-efficacy, CC knowledge, HPV knowledge, and cancer prevention behavior scores were higher in the PT group than in the non-PT group. Pap test attitude and Pap test self-efficacy were significant variables in the study by Jo (unpublished dissertation) on CC prevention education. In particular, Pap test self-efficacy was a facilitator of Pap screening practice.[10] Therefore, to prevent CC, the screening rate could be enhanced by promoting a positive attitude and higher self-efficacy toward the Pap test based on understanding the characteristics that demonstrate statistically significant differences. The PT group had significantly higher CC knowledge, HPV knowledge, and cancer prevention behavior scores than the non-PT group, which supported the results of a previous study.[18] Disease-related attitudes or lack of knowledge can act as barriers to Pap tests.[10] Thus, CC and HPV knowledge accumulation can improve understanding and motivation for proper health (cancer prevention) behavior, as well as promote a positive attitude, which could encourage participation in Pap testing.
Analysis of the factors influencing the Pap test experience identified marital status, employment status, experience of coitus, awareness of the NCSP, HPV vaccination, and Pap test self-efficacy as the influencing factors.
The OR of having a Pap test was 10.46 times higher among participants with coitus experience. This was much higher than the 5.6 times found in a study on nursing students,[18] which could be attributed to a difference in the study population. Women with coitus experience should be encouraged to take part in regular screening, while education that actively emphasizes the importance and practice of regular Pap test screening after having coitus experience should be provided as a CC prevention strategy.[18]
The OR of having a Pap test was 5.96 times higher among married versus unmarried individuals. This finding supports data showing that unmarried women in South Korean society are reluctant to undergo Pap tests owing to negative emotions, including embarrassment and stigma about receiving gynecological examinations.[8,9,11] Therefore, it is necessary to understand such barriers and to implement programs that actively encourage screening to prevent unmarried women from having such negative emotions. Moreover, urinalysis or vaginal self-sampling for CC screening could be an alternative for women who are reluctant to undergo Pap tests at healthcare institutions.[21–23] For this, standardization of self-sampling procedures and guides could contribute to improved screening rates and CC prevention.
The OR of having a Pap test was 4.39 times higher among those who had an awareness of the NCSP than among those who did not. Since 2016, women aged 20 to 29 years have been included in the NCSP in South Korea; however, because some women were unaware of this fact, this difference in the Pap test experience was observed. Thus, a lack of awareness may be a barrier to screening.[10]
Moreover, the OR of having a Pap test was 2.62 times higher among those who received HPV vaccination than among those who did not. This finding is consistent with the results of previous studies where vaccinated women were found to have increased awareness about the benefits, increasing their likelihood of undergoing a Pap test.[24] In addition, the OR was 2.22 times higher among employed versus unemployed individuals. The likelihood of receiving a Pap test increased 1.09 times with an increase of 1 point in the Pap test self-efficacy score. Self-efficacy may act as a facilitator of Pap test practice.[10] If the factors influencing Pap tests among women aged 20 to 39 years are properly understood and programs are customized according to the characteristics of the different age groups, the Pap test screening rate in this population may increase.
Finally, in the present study, a difference in the Pap test experience was evident between women in their 20s and 30s, although age was not found to be a significant determinant of the Pap test experience (P = .729). The average age of the participants at the time of their first sexual intercourse was 22.16 years, with the youngest reported age being 15 years. Moreover, even though 82 participants reported no history of sexual intercourse, Pap tests were performed on 10 of them. Sexual experience at an early age is a well-known risk factor for CC.[25,26] In Korean culture, the sexual behavior of young unmarried women is still considered taboo, which may impede their ability to access the Pap test.[8] However, young women who undergo screening are more likely to continue the practice as a lifelong habit and recommend it to their children and peers later.[10] Given that this was an online questionnaire survey study focused on women in their 20s and 30s, it is recommended that future studies include women at high risk for CC and samples drawn from hospital settings.
This study has some limitations. First, the study design was a cross-sectional survey. Second, only an online panel of South Korean women aged 20 to 39 years who voluntarily consented to participate in the study was included. Third, since information related to hysterectomy was not collected, women who had undergone hysterectomy could not be excluded. However, the reporting rate of hysterectomies in South Korea is very low.[19] Furthermore, as the study relied on self-reported online questionnaire surveys, the results may not be entirely accurate. Accordingly, caution should be exercised when interpreting the findings.
Despite these limitations, identifying the knowledge level or disease prevention experience of a particular population may provide an opportunity to change the awareness level and habits of the population in a favorable direction. Moreover, this study is significant in that the findings can be used as supporting data for establishing health policies for CC prevention.
5. Conclusion
Early screening for CC can improve the disease prognosis; thus, the active promotion of Pap test screening is of utmost importance. Accordingly, the present study investigated the status of Pap test screening in addition to identifying the influencing factors of Pap test screening among women aged 20 to 39 years who underwent the Pap test for the first time and were supposed to regularly receive the test in the future. It is essential to establish intervention strategies that target clinical practices, communities, and schools based on an understanding of the factors that influence Pap test uptake. The strategies could involve a range of measures, including implementing diverse publicity campaigns to increase access to the NCSP, providing cost support to increase HPV vaccination rates, and developing customized educational programs to enhance Pap test self-efficacy. Government policies with regard to CC prevention should prioritize understanding the needs of young women and providing intensive support to address those needs. The findings of the present study can inform the development of effective health strategies to improve the CC screening rate, utilizing the characteristics and influencing factors identified in this study.
Acknowledgments
We would like to thank all the participants who contributed to the production of this paper.
Author contributions
Conceptualization: Young A Kim.
Data curation: Yun Am Seo.
Formal analysis: Yun Am Seo.
Funding acquisition: Young A Kim.
Investigation: Yun Am Seo.
Methodology: Yun Am Seo, Young A Kim.
Project administration: Young A Kim.
Supervision: Young A Kim.
Validation: Yun Am Seo.
Writing – original draft: Yun Am Seo.
Writing – review & editing: Young A Kim.
Abbreviations:
- CC
- cervical cancer
- CI
- confidence interval
- HPV
- human papillomavirus
- NCSP
- National Cancer Screening Program
- non-PT
- no Pap test experience
- OR
- odds ratio
- Pap
- Papanicolaou,
- PT
- Pap test experience
This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (no. NRF-2020R1I1A3065986).
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Seo YA, Kim YA. Factors associated with Pap test screening among South Korean women aged 20 to 39 years. Medicine 2023;102:30(e34539).
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