title: Cervical cancer screening program in Thimphu, Bhutan: population coverage and characteristics associated with screening attendance.
abstract: BACKGROUND
  Bhutan has been engaged in good-quality cytology-based cervical screening since 2000 and has vaccinated >90% girls against human papillomavirus (HPV) since 2010. We explored the characteristics associated with lack of previous screening and screening coverage in women age ≥25 years.
  
  
  METHODS
  Women were invited at home or during their attendance at 2 outpatient clinics, in the capital, Thimphu, and nearby Lungthenphu. Age-adjusted odds ratios for lack of previous screening by selected characteristics were computed among 1,620 participating women. In Thimphu an invitation registry allowed to estimate screening history not only among participating women but also among additional 500 women who did not accept to join our study.
  
  
  RESULTS
  Among women who had a Pap smear, lack of previous screening was associated with age <35 or ≥45 years. It was also associated with some occupations; being single, or widowed/separated; and presence of HPV infection. Multiparity and use of contraceptive methods were associated with having been screened. In women invited at home in Thimphu screening history substantially differed by participation. Past screening attendance was 59% among women recruited in the 2 clinics, 53% in women who were invited from home and accepted the invitation, but only 25% in those who refused it. Based on all women recruited from home the estimate of population-based coverage in Thimphu is 34% (95% CI: 31-37).
  
  
  CONCLUSIONS
  Transition from an opportunistic screening to an all-reaching population-based screening is yet to be achieved in Bhutan, even in the capital. Better ways to target never-screened women are needed.
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France. baussanoi@iarc.fr.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Baussano
authors.affiliation: Department of Obstetrics & Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. ugentshomo2000@yahoo.com.
authors.forename: Ugyen
authors.initials: U
authors.lastname: Tshomo
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France. clifford@iarc.fr.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Clifford
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France. tenet@iarc.fr.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tenet
authors.affiliation: Department of Laboratory Services, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. doc_tshokey@yahoo.com.
authors.forename: Tshokey
authors.initials: T
authors.lastname: Tshokey
authors.affiliation: International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon Cedex 08, France. franceschi@iarc.fr.
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001631:Bhutan; D003268:Contraception Behavior; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D009790:Occupations; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis; D010298:Parity; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult