title: Cervical cancer knowledge and screening behaviors among female university graduates of year 2012 attending national graduate orientation program, Bhutan.
abstract: BACKGROUND
  Cervical cancer is the leading female cancer in Bhutan. This study describes the level of cervical cancer knowledge and screening behaviors among female university graduates attending the National Graduate Orientation Program (NGOP), 2012.
  
  
  METHODS
  A cross-sectional study of female graduates attending NGOP was conducted using self-administered anonymous questionnaire developed through literature reviews and expert discussions to elicit information on demographic characteristics, knowledge, screening behaviors and determinants of cervical cancer. The association of demographic and other important study characteristics with uptake of Pap test was investigated using cross tabulation and Fischer Exact test. Frequencies and percentages were calculated for all the questions.
  
  
  RESULTS
  The average age of the participants was 23.43 ± SD 2.73. About 92% (n = 513) of the respondents were aged 25 years or less and 7.9% (n = 44) of the respondents were aged 26 or more. The study revealed low cervical cancer knowledge and poor screening behavior among the graduates. The mean knowledge score was 3.571 (SD1.75, Range 0-8). About 6% (n=34) of the respondents reported undergoing Pap test at least once and 94% reported as never having done Pap test. The most commonly cited reasons for not doing Pap test included "never thought I needed one" (57%, n = 320), "embarrassment of being examined by male health professional" and "fear of finding out cancer". The study revealed evidence of significant association between increasing age, those who are married, knowledge score and those recommended for screening by health professionals with the uptake of Pap test.
  
  
  CONCLUSIONS
  Our study revealed poor knowledge and screening behaviors among female university graduates in Bhutan. This may be suggestive of even poorer awareness and screening practices among young unmarried women who are less educated or with no education. Although our study group is not appropriate for measuring practice of cervical cancer screening in the country, the findings are expected to highlight the shortcomings and trigger development of comprehensive cervical cancer control programs in Bhutan.
authors.affiliation: Head, Health Research and Epidemiology Unit, Planning and Policy Division, Ministry of Heath, Kawangjangsa, Thimphu, Bhutan. tdhruihr@gmail.com.
authors.forename: Tshering
authors.initials: T
authors.lastname: Dhendup
authors.forename: Pandup
authors.initials: P
authors.lastname: Tshering
mesh_terms: D000328:Adult; D001631:Bhutan; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017533:Marital Status; D065006:Papanicolaou Test / Q000523:psychology; D012307:Risk Factors; D013334:Students / Q000523:psychology; D011795:Surveys and Questionnaires; D014495:Universities; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult