Factors Associated with Under- and Over-Screening for Cervical Cancer in Rural Areas of Cuenca, Ecuador

Background: Cervical cancer (CC) remains a leading cause of death among women worldwide despite the availability of effective preventive strategies. In Ecuador, CC is the second most prevalent cancer among women. However, many women in rural areas remain inadequately screened, resulting in both underscreening and overscreening patterns. Objective: To identify the determinants associated with under- and overscreening for CC among women in rural areas of Cuenca, Ecuador. Methods: A cross-sectional, door-to-door survey was conducted between September and December 2023 in the rural parishes of Nulti and Chiquintad. A total of 1692 women aged 18 years and older were included. Participants were categorized as under-, optimally, or overscreened based on self-reported Pap test frequency according to the World Health Organization (WHO) recommended 3-to-5-year screening intervals. Odds ratio (OR) with 95% confidence intervals (CI) were calculated to identify associated factors. Results: Among the participants, 42.7% were underscreened, 19.3% optimally screened, and 37.9% overscreened. Underscreening was associated with being older than 45 years, having a low educational level, being single, experiencing embarrassment during genital examination, and lack of time. Overscreening was associated with being younger than 45 years, having higher education, and a strong willingness to undergo screening. Conclusions: Targeted interventions should address informational and emotional barriers contributing to underscreening while discouraging unnecessary overscreening. Strengthened counseling, public education, and standardized guidelines could improve the efficiency and equity of CC screening programs.