Introduction
Cancer is a public health problem both in our country
and worldwide, with a tendency to increase its burden, fatality, and incidence.[] According to the
GLOBOCAN 2012 data, there were 14.1 million new
cancer cases and 8.2 million cancer-related deaths in
the world in 2012.[] The World Health Organization (WHO) estimated that 20 and 24 million people, respectively,
would be diagnosed with cancer in 2020
and 2030; 17 million people would die due to cancer
in 2030; and 75 million people would live with cancer
in 2030.[] When projections are made about the current
rate of increase, it is estimated that the incidence
of cancer in our country will double and reach to 450
per 100.000 in 2030s.[]
A rapid increase in the cancer burden has become
a global crisis for public health and health systems. A
major problem for many countries will be to treat all
cancer patients diagnosed in the coming years and to
ensure an adequate funding for palliative, supportive,
and terminal care.[]
As in the rest of the world, the increasing importance
of cancer highlights its cost, early detection, and
diagnosing in our country.[] The cheapest way to prevent
cancer is to educate individuals and apply screening
methods to individuals from the risk groups.[]
Primary and secondary prevention gains importance if
we particularly consider the cancers that can be prevented,
death from cancer can be eliminated by screening
and an early treatment contributes a lot to the quality
of life.[] Community-based screening programs
for the detection of patients with breast and cervical
and colorectal cancer at early stages are recommended
by the WHO.[] If the prevention activities can be
widely applied, these measures will contribute to the
alleviation of the global cancer burden.[] In line with
this goal, it is necessary to plan activities to battle with
cancer consciously and to produce rational policies.
For this purpose, all the activities under the National
Cancer Control Program in our country are carried
out under four main headings: prevention, screening,
early detection, treatment, and palliative care. In all of
these areas, it is important to raise awareness of cancer
in individuals to be able to make successful policies.[]
The purpose of this study was to determine the
early cancer detection/screening behaviors of the individuals
aged ?40 years without any previous cancer diagnosis
and its influencing factors. We believe that the
results of the study may provide a basis for the content
of future educational programs toward the prevention
and early cancer detection and to contribute to the development
of applicable strategies and policies to fight
against cancer.
Methods
This descriptive research was conducted between 15th
December, 2011, and 30th January, 2012, in the center of Trabzon, Turkey. The universe of the research comprised
105.071 individuals aged ≥40 years living in
the center of Trabzon. It was assumed that the cancer
screening rate was 40% in urban areas, and the number
of the individuals sampled was calculated as 1.200 at
Β=0.20, the power of 80%, and ?=0.05. In the selection
of the sample, 30 cluster sampling methods proposed
by the WHO for the developing countries were used.
As the cluster unit, a neighborhood was identified.
There were 40 individuals from each cluster selected,
and the questionnaire was completed with 1.200 individuals.
Both the genders were equally represented in
the sample.
For the sample selection, the ratio of the population
aged ≥40 years living in the center of Trabzon to
the general population was first calculated according to
the gender and age groups by using the Address Based
Population Registration System (ABPRS) data. The
number of individuals to be sampled was then calculated
according to the gender and age groups. In the
calculation, the ratio of the relevant gender and age
groups to the general population of Trabzon was taken
into account.
In the sample selection, the information regarding
the gender, age, neighborhood, and address of the
people aged ≥40 years was requested. For this purpose,
computer software was created using the ABPRS
data. The computer software was first used to identify
the neighborhoods of the individuals aged ≥40 years
living in the city center, and then those living in each
neighborhood were divided according to their gender,
and then the lists were formed according to the
age groups. A simple random sampling method was
used to determine the first individual to be sampled,
and the systematic sampling method was used to select
the others.
An approval was obtained from the Karadeniz
Technical University Ethics Committee to conduct the
research, and written permission was received from
the Governorship of Trabzon for the application of the
survey form. A verbal approval was also obtained from
the individuals who agreed to participate voluntarily in
the research.
For the research, after reviewing the literature [-] and receiving expert opinions about the subject, a
survey form was developed by the researcher. Survey
questions were prepared to determine the socio-demographic
characteristics of the individuals, their early
detection/screening behaviors, its influencing factors
regarding the cancer types (breast, cervix) for which
early diagnosis/screening programs are recommended by the WHO, and the cancer types for which early detection
programs are recommended but screening programs
are not (oral cavity, stomach, colorectal, skin,
ovaries, and prostate).
The data were collected by eight trained interviewers.
They visited the individuals at their addresses,
and they excluded the individuals with psychiatric
and neurological disorders that impeded communication
and those who had previously been diagnosed
with cancer. Instead, they selected the next individual
from the same gender and age groups from the list. At
the beginning of the interview, the individuals were
informed about the survey, and it was stated that the
response time was 20-25 minutes. The individuals
who could not be found at their address on the first
visit were visited for the second time. The next individual
from the same gender and age groups on the
list was visited instead of the unreachable one on the
third visit.
In the evaluation of research data, a computer package
program was used. The results were presented with
numbers, percentages, and averages as descriptive statistics.
A chi-squared test and logistic regression were
used in the analysis of the data, and a p-value <0.05 was
considered to be statistically significant. In the logistic
regression analysis, the independent variables that
might affect the breast self exam (BSE), clinical breast
examination (CBE), a mammogram, a Pap smear, a
fecal occult blood test (FOB), a colonoscopy, and a
prostate-specific antigen (PSA) test were included in
the model.
The independent variables were accepted as the
gender, age, marital status, educational status, health
insurance, income status, monthly income, the place
where the individual lived the longest, cancer history
in first-degree relatives (parents, siblings), cancer death
among first-degree relatives, and the dependent variables were accepted as early cancer detection/screening
behaviors.
The fact that the results obtained from this study
could be generalized only to the individuals living in
the center of Trabzon and that the individuals aged ≥40
years were included in the research were considered to
be the research limitations.
Results
50.0% of the individuals in the study group were male
and 50.0% were female, the average age was 54.90±11.16
years, 54.9% had the elementary and lower education
level, 86.0% were married, and 96.9% had health insurance.
It was found that 45.3% of the women had BSE,
22.7% had CBE, 14.3% had a mammogram, and
29.2% had a Pap smear. It was determined that 16.1%
and 15.2% of the whole group had an FOB test and
colonoscopy, respectively, and 15.8% of men had a PSA
test (Table 1).
Table 1: Early diagnosis/screening test/examinations performed in the research group
In the logistic analysis, BSE was performed in the
age group of 40?54 years at the rate 2.1 (1/0.49) and 2.3
times (1/0.43) greater than in the age groups of 55-64
and ≥65, respectively; those with health insurance had
it at the rate 3.2 greater than those without health insurance;
those with secondary/high school and university
education had it at the rate 1.4 and 3.7 times
greater, respectively, than those who were illiterate/
literate/primary school graduates; those who had cancer
history in first-degree relatives had it at the rate 1.6
times greater than those who did not (Table 2).
Table 2: The logistic regression analysis of the independent variables that could affect having a BSE, a CBE, or a mammogram
According to the logistic analysis, individuals
with a good income had CBE at the rate 2.4 greater
than those with a low/middle income; those with the
1000-1999TL, 2000-2999TL, and ≥3000TL monthly
income had CBEs at a rate 1.6 (1/0.63), 2.7 (1/0.37),
and 2 (1/0.50) times greater than those with ≤999 TL monthly
income, respectively. It was determined that
the individuals who had cancer history in first-degree
relatives had CBE at a rate 2.8 times greater than those
who did not (Table 2).
The logistic analysis demonstrated that the individuals
who had health insurance had a mammogram
7.1 times more frequently than those who did not have
health insurance, and those who had cancer death history
among the first-degree relatives had a mammogram
2.4 times more frequently than those who did not
have the history (Table 2).
In the logistic analysis, the age group of 40?54 had a
Pap smear 1.2 (1/0.86) and 2.7 times (1/0.37) more frequently
than the age groups of 55-64 and the ?65, respectively; those who had cancer history in first-degree
relatives had it 1.8 times more frequently than those
who did not (Table 3).
Table 3: The logistic regression analysis of the independent variables that may have effect on a Pap smear test
According to the logistic analysis, a FOB test was
performed by the age groups of 55-64 and ≥65, and
these groups had it at a rate 1.6 and 1.9 times greater,
respectively, than the age group of 40-54; men had
it 1.8 (1/0.55) times more frequently than women
(1/0.55); those with a good income had it 2.5 times
more frequently than those with a low/middle income
(Table 4).
Table 4: The logistic regression analysis of the independent variables that may have an effect on colonoscopy and FOB tests
According to the logistic analysis, the age groups
of 55-64 and ≥65 had colonoscopy at a rate 1.3 and
2.4 times greater than the age group of 40-54, respectively; those with a good income level had it 2.7
times more frequently than those with a low-/middle
income level; those who lived in rural areas the
longest had it 1.7 times (1/0.58) more frequently than
those who lived in urban areas the longest; those with
cancer death history among first-degree relatives had
colonoscopy 1.5 times more frequently than those
who did not (Table 4).
In the logistic analysis, the individuals who did not
have cancer history in first-degree relatives had PSA 4.8 (1/0.21) times more often than those who did not
have the history; and those who had cancer death history
among first-degree relatives had 6.6 times more
PSA than those who did not (Table 5).
Table 5: The logistic regression analysis of the independent variables that may have an effect on PSA tests
Discussion
Like in the rest of the world, an increasing importance
of cancer highlights its costs, early detection, and diagnosis in our country as well.[] The cheapest way to
prevent cancer is to train individuals and apply screening
methods to individuals from the risk groups.[]
In the studies conducted in Turkey, it was found
that the rate of a BSE application was low.[] In
our country and abroad, the studies show that the
incidence of BSE varies greatly, and the frequency
of breast self-examination in Turkey varies between
4.3% and 42.0%.[] While the rate of the women
who performed a BSE ranged from 37.4% to 59.8%,
the rate of the women who performed a regular BSE
was determined as minimum 5.9% and maximum
17.9%.[] The rate of women performing BSE regularly
is quite different in other countries, too. The
rate of those who regularly conduct BSE on a monthly
basis was 2.9% in a study conducted in South Korea,
7.3% in Nigeria, and 32% in African Americans.[]
In our study, 45.3% of women were found to have
performed a BSE. The BSE frequency was found to
be 5.5% in a study by Seçginli and 48.1% in a study
of by Rizalar and Altay.[] In a study carried out in
Çorum, it was found that there were 27.2% of women
who performed a regular BSE.[] A study conducted
in Singapore reported that 93.0% of nurses performed
a BSE.[] Gürsoy et al. stated that the women who
were 41 years or older, married, and had cancer, but
not breast cancer in their family, performed a BSE
at a higher level, and the rate of performing a BSE
increased as the level of education increased. In the
same study, those whose mothers or sisters had cancer
and those who had any breast disease had performed
BSE more than those who did not.[] Dişcigil et al.
argued that the rate of performing a BSE increased
as the level of education and the status of having a
family history of breast cancer increased.[] Similar
to the results from the other studies, the level of education
and the presence of a family history of cancer
in the first-degree relatives were also found as the
variables that increased the rate of performing a BSE in our study. It can be said that compared to screening
tests, women"s awareness that a BSE enables them to
recognize the changes in their breasts was quite good.
However, it is also necessary to target performing a
BSE correctly and regularly every month.
The ratio of women who had a CBE varied from
21.1% to 42.7% in the studies carried out in our country.[] In our study, it was determined that 22.7% of
women had a CBE. The rate of the women who had
a CBE was found at 42.7% by Dişcigil et al.[], and
19.8% by Gürsoy et al.[] In the same study, the age,
marital status, and family history of cancer and breast
cancer were found to be significant variables affecting
CBE. The women aged 41 and over, who were married,
and with a family history of cancer and breast cancer
had a CBE higher rate.[] In a study conducted in Singapore,
the rate of nurses who had a BSE was 53.6%.
[] Odunsaya and Tayo reported that 30% of nurses
had a CBE in the past 3 years [], and Chang et al.
reported that 53.6% of nurses had a CBE.[] In our
study, the presence of family history of cancer in firstdegree
relatives was found to be an effective factor for
CBE, similar to the results of a previous study conducted
in our city.
In our study, 14.3% of women had mammography.
Şeker et al. reported that 45.4% of those over 40 had
mammography.[] 20.9% of participants in a study by
Özer et al.[], 7.3% of nurses in a study by Özdemir
et al.[], 12.5% of women in a study by Canbulat and
Uzun [], and 15.0% of women in a study by Gürsoy
et al. were found to have had a mammogram.[] In
addition, significant variables affecting having a mammogram
in the same study were found to be the age,
marital status, health insurance, and a family history
of cancer and breast cancer. Women who were aged
41 and over, married, had health insurance, and had a
family history of cancer and breast cancer were found
to have a higher mammogram rate as well.[] Dişcigil
et al. pointed out that a higher education level in women was not related to the mammogram rate, but
the women with the family history of breast cancer
were more sensitive to a mammogram, and the women
who were informed about breast health by physicians
used more screening methods than other women.[]
In a study conducted by Açıkgöz et al., the women in
the age group of 50-59 were found to have a mammogram
more frequently than those who were younger
or older, and those who had health insurance had a
mammogram more frequently than those who did
not.[] The rate of having mammography in different
countries in the past 2 years varies between 43.0% and
78.0%.[] Chang et al. and Odunsaya and Tayo, respectively,
found that 68.1% [] and 8.0% of nurses
had mammography in the past 3 years.[] In a study
conducted in Singapore, the rate of having mammography
in nurses aged ≥50 years was found to be 64.8%,
and 31.1% in those <50.[] In the studies conducted
in Turkey, whether a woman had mammography or
not was examined rather than how frequently she had
it. Very few studies investigated the frequency of having
mammography.[] In our study, the rate of having
a mammogram was similar to the results from a previously
reported study by Gürsoy et al. The presence of
health insurance and having a family history of cancer
in the first-degree relatives in our study was also found
to be consistent with the literature.
In our study, it was determined that 29.2% of
women had a Pap smear. Türkol et al. and Özdemir
et al.[] found that 23.5% and 23.7% of women, respectively,
had a Pap smear.[] Şeker et al. reported
that 20.7% of patients aged >30 years had a Pap smear.
[] Tarwireyi et al. stated that 18.3% of health workers
had a Pap smear, and in another study in Hongkong,
45.0% had it.[] In a study conducted in the United
States, it was found that the variables that motivated
women to have a Pap smear were the socioeconomic
status and cultural level. In the same study, according
to the logistic analysis, the women who knew that the
Pap smear test was the best diagnostic method for the
early detection of cervical cancer were found to have a
test five times more likely than other women.[] In a
study conducted in Botswana, the most important reasons
that prevented the Pap smear test to be applied
were found to be the lack of adequate information
about the Pap smear, negative attitudes of health care
providers, and the limited access to physicians.[] In a
study conducted in the United States, it was found that
the first and second most effective factors to have a Pap
smear test was a doctor's recommendation and having
health insurance, respectively.[] Açıkgöz et al. found that being married, and having high school and higher
education in the age group 40-49 years were the main
determinants to have a Pap smear.[] In a study conducted
in Kayseri, while a significant difference was
found in having a Pap smear with regard to having
knowledge about cervical cancer, age, working status,
the level of education, and income, the status of having
a Pap smear test in the past 3 years showed a significant
difference based on age and the income level.[]
Similar to the results from related studies, women in
our study also had a low screening rate for the early
detection of cervical cancer.
It is recommended that individuals aged 50?80
years who are not in the risk groups should have an
FOB test every 1 to 2 years.[] In our study, it was found
that 16.1% of the individuals had a FOBT. Çakmak et
al. found that only two women had a FOB test in their
study that involved female health workers.[] The
high rate in our study is thought to be due to the fact
that it was conducted in individuals aged ≥40 years.
Colorectal cancer is a type of cancer which incidence
has increased in recent years and ranks third
in both genders in our country. According to the national
cancer screening standards, for the early diagnosis
of this type of cancer, individuals aged ≥50
years are included in the scope of the FOB test and
colonoscopy routine screening services.[] The national
standards for colorectal cancer screening in our
country are the fecal occult blood test (FOBT) and
biopsy colonoscopy every 10 years.[] 15.2% participants
had a colonoscopy in our study. In a study
conducted by Açıkgöz et al., it was found that 90.1%
of women had no colonoscopy procedures, and there
was not any difference between the socioeconomic
and health characteristics of the women and their
colonoscopy behavior.[] Pirinçci et al. determined
that the rate of colorectal cancer screening was 18.3%.
Of these patients, 77.6% had a FOB test, and 21.6%
had rectosigmoidoscopy/colonoscopy.[] The rate of
having a colonoscopy in our study was found to be
low, in compliance with the literature. The fact that
nearly all of the examination was ordered by doctor
reveals that the individuals used the screening test for
the early detection at a very low level.
15.8% of men had PSA in our study. In a study conducted
by Bilgili and Kitiş in Ankara, the rate of PSA
test was found as 20.9%.[] Kaya et al. determined
that the rate of cancer screening on regular basis was
statistically significant in those who had a cancer diagnosis
or who had someone in her/his family or around
him/her with a cancer diagnosis (p<0.001).[] In our study, the PSA test was found to be used as low as other
screening tests/ examinations.
As a result, we found that the rates of early diagnosis/
screening tests/examinations for cancer were very
low in our study. The effective variables on screening
behaviors were determined as the age, education level,
health insurance, cancer history in first-degree relatives
for BSE; income, monthly income, first-degree
death from cancer for CBE; health assurance, firstdegree
relative death from cancer for mammography;
age, cancer history in first-degree relatives for the Pap
smear; age, gender, income for FOBT; age, income, the
place where the individuals lived the longest, first-degree
relative death from cancer for colonoscopy; cancer
history in first-degree relatives, and first-degree relative
death from cancer for PSA.
Programs should be developed to raise the public
awareness on early detection/screening tests/examinations
to reduce cancer morbidity and mortality, and
strategies should be developed to increase the use of
early detection/screening tests. Taking the results of
this research into consideration, it is thought that it
can help to make the right planning in the fight against
cancer in Trabzon.
Conclusion
The results of this study reveal that individuals perform
cancer early detection/screening tests at very low
levels, and gender, age, educational status, the place of
residence where individuals live the longest, health insurance,
income level, family history of cancer in first
degree relatives and cancer diagnosis in first-degree
relatives are the variables that affect early diagnosis/
screening tests.
Peer-review: Externally peer-reviewed.
Conflict of Interest: The authors declared no conflicts of
interest.
Ethics Committee Approval: An approval was obtained
from the Karadeniz Technical University Ethics Committee
to conduct the research.
Financial Support: This research was supported by Erciyes
University Scientific Research Coordination Unit (Project
No: TSD-3954). We would like to thank Erciyes University
Scientific Research Coordination Unit for supporting the research.
Authorship contributions: Concept ? H.K., F.Ç.; Design
? H.K.,F.Ç.; Supervision ? H.K.,F.Ç.; Materials ? H.K.; Data
collection &/or processing ? H.K.; Analysis and/or interpretation? H.K., F.Ç.; Literature search ? H.K.; Writing ? H.K.;
Critical review ? H.K., F.Ç.
References
Tuncer M, ed. Cancer control in Turkey. Ankara: Koza
Publishing; 2009. p. 5-410.
GLOBOCAN 2012: Estimated cancer incidence,
mortality and prevalence worldwide in 2012. Access:
[http://globocan.iarc.fr/Pages/ fact_sheets _population.
aspx]. Accessed 12 July 2017.
Boyle P, Levin B, Eds. World Cancer Report 2008.
Lyon: International Agency for Cancer Research:
2008. p.12-497.
Turkey Health Report 2012. Public Health Experts Association
2012;1-527.
Arıca S, Nazlıcan E, Özer C, Şilfeler DB, Arıca V,
Özgür T, et al. The frequency and distribution of
cancer cases in Hatay in 2008. J Clin Exp Invest
2011;2(2):192-5.
Kaya C, Üstü Y, Özyörük E, Aydemir Ö, Şimşek Ç,
Şahin AD. Knowledge, attitudes and behaviors of
health workers about cancer screenings. Ankara Med J
2017;17(1):73-83.
Gültekin M, Özgül N, Olcayto E, Tuncer M. An examination
and evaluation of the level of knowledge of
Turkish people about cancer and cancer risk factors. J
Society Obst Gyne 2011;8:57-61.
Platin N, ed. Basic Concepts in Cancer Nursing.
Ankara: Technical Report Series of Int Cancer Fight
Union; 1987. p. 39.
Kutluk T, Kars A. General Information About Cancer.
Turkish Association of Cancer Research and Control
Publications. Ankara: Prime Ministry Printing House;
1994.p. 40-7.
Platin N, Ed. Cancer Handbook for Nurses. IV edition.
Ankara: Evening Art Schools Printing House, 1996.
Secginli S, Nahcivan NO. Factors associated with
breast cancer screening behaviors in a sample of Turkish
woman: A questionnaire survey. Int J Nurs Stud
2006;43(2):161-71.
Yapucu Güneş Ü, Zaybak A, Eşer İ, Khorshid L.
Cancer risk factors in healthy individuals. Ege University
J Nurs School 2007;23(2):13-22.
Pınar G, Algıer L, Doğan N, Kaya N. Determination
of risk factors in the individuals with gynecologic cancers.
UHOD 2008;18(4):208-16.
Tuncer M, Özgül N, Gültekin M, Ed. European Union
Guideline for Quality Control in Cervical Cancer
Screenings. Ankara: Koza Publishing; 2009. p. 21.
Malvezzi M, Arfé A, Bertuccio P, Levi F, La Vecchia C,
Negri E. European cancer mortality predictions for the
year 2011. Ann Oncol 2011;22(4):947-56.
Karabulutlu Ö. Risk factors in cervical cancer, early
diagnosis methods, prevention and role of a nurse.
STED 2013;23(2):74-9.
Akkaş Gürsoy A, Yiğitbaş Ç, Yılmaz F, Erdöl H, Kobya
Bulut H, Karadeniz Mumcu H, et al. The effects of peer
education on university students" knowledge of breast
self-examination and health beliefs. J Cancer Educ
2009;24(4):331-3.
Babuş S, Eser E. A research on the knowledge, attitudes
and behaviours towards breast cancer and the
methods for early diagnosis in two selected areas of
Manisa. STED 2017;26(6):221-30.
Akkaş Gürsoy A, Yılmaz F, Nural N, Kahriman İ,
Yiğitbaş Ç, Erdöl H, et al. A different approach to
breast self-examination education: daughters educating
mothers creates positive results in Turkey. Cancer
Nurs 2009;32(2):127-34.
Açıkgöz A, Çehreli R, Ellidokuz H. Hastanede çalışan
kadınların meme kanseri konusunda erken tanı yöntemlerine
yönelik bilgi ve davranışlarının belirlenmesi,
uygulanan planlı eğitimin etkinliğinin incelenmesi.
J Breast Health 2015;11:31-8.
Rızalar S, Altay B. Early diagnosis of applications in
the women with breast cancer women. J Fırat Health
Serv 2010;5:73-87.
Akpınar YY, Baykan Z, Naçar M, Gün İ, Çetinkaya F.
Knowledge, attitude about breast cancer and practice
of breast cancer screening among female healthcare
professionals: A study from Turkey. Asian Pasific J
Cancer Prev 2011;12(11):3063-8.
Gençtürk N. Female health professionals" status of
knowing and applying the breast cancer early diagnosis
methods. The Journal of Breast Health 2013;(9)1:5-9.
Akkaş Gürsoy A, Karadeniz Mumcu H, Yeşilçiçek
Çalık K, Kobya Bulut H, Nural N, Kahriman İ, et al.
Attidudes and health beliefs associated with breast
cancer screening behaviors among Turkish women. J
Transcultural Nurs 2011;22(4):368-75.
Dişcigil G, Şensoy N, Tekin N, Söylemez A. Breast
health: knowledge, behavior and practices of a group
of women living in the Aegean Region. Marmara Medical
J 2007;20(1):29-36.
Odunsaya OO, Tayo OO. Breast cancer knowledge, attitudes
and practice among nurses in Lagos, Nigeria.
Acta Ongol 2001;40(7):844-8.
Chang PN, Krishnan M, Hong CY, Swah TS. Knowledge
and practice of breast cancer screening amongst
public health nurses in Singapore. Singapore Med J
2002;43(10):509-16.
Şeker N, Yasin YK, Özaydın E, Çapacı B, Okyay P.
Knowlwdge of nurses" in tertiary health care instituons
about cancer screening programs and status of screening
tests. Düzce Med Faculty J 2017;19(1):14-18.
Özer A, Bankaoğlu E, Ekerbiçer HÇ, Hüdayioğlu MR,
Özdemir M. The status of having self-breast examination
of a group of women living in Kahramanmaraş
and its affecting factors. Bulletin of Community Med
2009;28:14-9.
Özdemir Ö, Bilgili N. Knowledge and practices of
nurses working in a training hospital early diagnosis of
breast and cervical cancer. TAF Prev Med Bull 2010;9:
605-12.
Canbulat N, Uzun O. Health beliefs and breast cancer
screening behaviors among female healthworkers in
Turkey. European J Oncology Nurs 2008;12(2):148-56.
Akkaş Gürsoy A, Hintistan S, Nural N, Kahriman
İ, Yılmaz F, Yiğitbaş Ç, et al. A comparison of three
educational interventions on breast self-examination
knowledge and healthbeliefs. Asian Pasific J Cancer
Prev 2009;10(5):765-72.
Açıkgöz A, Çehreli R, Ellidokuz H. Women's knowledge
and attitudes about cancer and their behavior towards
early diagnosis methods. DEÜ J Medicine Faculty
2011;25(3):145-54.
Türkol E, Güneş G, Özen G, Omaç M. Information,
attitudes and behaviors of women about cervical cancer,
Pap smear and HPV vaccination. J New World Sci
Academy 2009;4:67-74.
Tarwireyi F, Chirenje ZM, Rusakaniko R. Cancer of the
servix: knowledge, beliefs and screening behaviours
of health workers in Mudzi Districtin Mashonaland
East Province, Zimbabwe. Cent Afr J Med 2003;49(7-
8):83-6.
Lee EE, Fogg L, Menon U. Knowledge and beliefs
related to cervical cancer and screening among
Korean American woman. Western J Nurs. Research
2008;30(8):960-73.
McFarland DM. Cervical cancer and Pap smear
screening in Botswana: knowledge and perceptions.
Int Nurs Rev 2003;50(3):167-75.
Ma GX, Fang CY, Feng Z, Tan Y, Gao W, Ge S, et al.
Correlates of cervical cancer screening among Vietnamese
American woman. Infectious Diseases in Obst
Gyne 2012. p.11. doi:10.1155/2012/617234.
Şenol V, Balcı E, Çetinkaya F, Elmalı F. Woman"s
knowledge and behavior on cervical cancer in Kayseri,
Turkey. Türkiye Clinics J Med Sci 2012;32(3):694?701.
Çakmak R, Güler G. Cancer screening behaviors in
female health workers. Türk Jinekolojik Onkoloji Dergisi
2017;20(1):25-32.
Pirinççi S, Benli C, Okyay P.Patients admitted to
tertiary health care center colorectal cancer screening
program awareness study. TAF Prev Med Bull
2015;14(3):209-14.
Bilgili N, Kitiş Y. Health beliefs regarding prostate
cancer screening in men and its affecting factors. 16th
National Public Health Congress, Abstracts Book;
2013.p. 419.
