Cervical cancer screening is the systematic application of a test to identify cervical abnormalities in an asymptomatic population. It is testing of women at risk of cervical cancer that aims to detect precancerous changes, which, if not treated, may lead to cancer. Women targeted for screening may feel perfectly healthy and see no reason to visit health facilities . Women who have abnormalities on screening need follow-up, diagnosis, and possibly treatment, to prevent the development of cancer or to treat cancer at an early stage .
Screening service is recommended to be performed for sexually active females with age 21–65 years. Screening after a woman's age greater than 65 years old is not necessary . From these screening tests, Pap smear and visual inspection with acetic acid are the commonest .
A Pap test is performed by scraping off some cells from the surface of the cervix using a spatula and a brush and then cancer cells are identified through a microscopic examination. It identifies women who may have pre-invasive or early cancerous changes. It is recommended that a Pap test for cervical screening would be conducted within three years of the initiation of sexual activity or at the age of 21 whichever occurs earlier. Rescreening is reduced to every two to three years until the age of 69 if the first two smears are normal at the discretion of the physician .
In areas where Pap smear screening is not available or affordable, visual inspection of the cervix, using acetic acid to highlight precancerous lesions so they can be viewed with the naked eye, is also currently available .
Cervical cancer is the easiest gynecologic cancer to prevent with effective screening practices. The availability of relatively simple screening tests to detect premalignant lesions and the availability of the human papillomavirus vaccine made the proverb 'prevention is better than cure' appropriate for cervical cancer . Additionally, cervical cancer has a long premalignant period that provides the opportunity to screen and treat it before it becomes invasive cervical cancer . Along with this, it is largely preventable by effective screening programs. Effective screening can reduce the risk of developing invasive cervical cancer by 90% .
The large decline in cervical cancer mortality in developed countries had been attributed to widespread screening. It is 80% in Austria and Luxemburg, 79% in Georgia, and 73% in Brazil .
Despite the higher burden of the cervical case and the fact that easily preventable, the coverage of the screening program for highly affected women in developing countries remained at less than 5%. In Nigeria and Kenya, the rate of screening program coverage was below 5.3% and 3.2% respectively. In West Africa, Less than 1% of women in four countries had ever been screened .
In Ethiopia, studies have shown that uptake of cervical cancer screening is very low, for example, in the towns of Arbaminch (5.9%) , Addis Abeba (3.5%) , Mekelle (10.7%)  and Dessie (11%) compared to the National cervical cancer prevention strategic plan (80%) set by Federal Ministry of Health of Ethiopia .
Low cervical cancer screening coverage in developing countries made the disease to be present at an advanced stage that requires extensive treatment modalities like surgery, radiotherapy, and chemotherapy and has a markedly diminished chance of success In addition, these treatment modalities may be lacking altogether, or too expensive and inaccessible for many women and if left untreated, invasive cervical cancer is almost always fatal, causing enormous pain and suffering for the individual and having significant adverse effects on the welfare of their families and community . The 2009 World Health Organization report depicts the urgent need for action to increase the utilization of cervical cancer screening very clearly. The report suggests that in Ethiopia, the rate of age-adjusted cervical cancer is around 27.5 per 100,000 patients. The increment in new cases per year is 7619 and deaths per year are reported as 6081. Without urgent attention, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years . The World Health Organization (WHO) and the American Cancer Society (ACS) recommended that all age-eligible women should have cervical cancer screening at least once every five years .
Knowledge and attitude towards cervical cancer screening, perception of susceptibility, age, occupation, income, pregnancy history, and ever-use modern contraceptives are key determinants of self-reported uptake of cervical screening revealed by previous studies in other regions [15,16,17]. Very little is known about cervical cancer screening and physician recommendations. So this thesis is regarding the determinants of cervical cancer screening utilization.
Identifying the determinants of cervical cancer screening utilization could result in one of the most significant successes to decrease women's mortality and morbidity related to cervical cancer in Dessie town as well as in the country by achieving the national cervical cancer prevention strategic plans set by the Federal Ministry of Health. Additionally, it can be used as a tool in achieving a health sector transformation plan and national sexual and reproductive health strategy.