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Cervical Screening Non-Participation: beyond psycho-emotional reasons. By Tatjana Doronda

Updated: May 27, 2019

Cervical screening uptake has been slowly falling in the United Kingdom. A research group at University College London conducted a study to explore this trend. The group interviewed 3,113 screening-eligible women to assess their screening uptake and intention to be screened in future. A total of 793 women were identified as non-participants in cervical screening. The three main reasons were :

1. 51% (n=406) of women were intending to have screening but were currently overdue

2. 28% (n=219) were unaware of screening

3. 15% (n=118) had decided not to be screened

So around half of the non-attenders were intending to be screened, but hadn't got around to it. The majority of this group were aged 25-35 years, single and from lower social grades (Marlow et al., 2017).

The media often reports psycho-emotional reasons, such as women’s embarrassment and fear of the cervical screening test, as the main reason for the delayed attendance. However, a recent social media campaign suggests otherwise.

In April 2019, an online campaign supported by the charities Jo's Cervical Cancer Trust and The Eve Appeal was set up by the Women’s Equality Party, UK. The aim was to draw attention to life-saving cervical cancer tests becoming increasingly inaccessible and inconvenient test scheduling at under-pressure surgeries. As part of the campaign, pictures of flowers resembling female genitalia accompanied by the hashtag #notashrinkingviolet were shared on social media, with many copying the Health Secretary Matt Hancock in to their posts.

This initiative was ironically described as a "public cervix announcement". In comments on social media many women expressed their intentions to get screened, but were unable to make an appointment due to the limited slots available at convenient times. Campaigners said it was inappropriate that women's embarrassment about their bodies was singled out as a cause of the 20-year drop in screening attendance: “I'm not shy, I just can't get an appointment!” Guilene Marco @GuileneMarco

Indeed, another study compared barriers expressed by women who were up-to-date with screening versus those who were overdue. Interviews were carried out with 580 women aged 26–64 years. The study found that practical barriers, such as ‘difficulty making an appointment’, ‘not getting round to it’, and lack of trust in the smear test were more predictive of screening non-attendance than emotional factors, such as embarrassment (Waller, 2009).

Making cervical screening accessible and an easy process is an important requirement if we are to eliminate one of the most preventable cancers on a national level.

On a positive note, WEP's campaign was publicly endorsed by the Minister for Health:

“I warmly welcome @WEP_UK’s good work in raising awareness on cervical cancer - including today’s campaign. We can & must do more to encourage & better support women to have smear tests. Together we can beat cervical cancer. #NotAShrinkingViolet

Matt Hancock @MattHancock

This response sounds promising!

Editing support by Dr Rebecca Richards.


Albrow, R., Blomberg, K, Kitchener, H., Brabin, L., Patnick, J., Tishelman, C. et al. (2014). Interventions to improve cervical cancer screening uptake amongst young women: a systematic review. Acta Oncol, 53(4), 445-451

Marlow, L., Chorley, A., Haddrell, J; Ferrer, R; Waller, J; (2017). Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women. European Journal of Cancer, 80, 30-38.

Waller, J., Bartoszek, M., Marlow, L. & Wardle, J. (2009). Barriers to cervical cancer screening attendance in England: a population-based survey. J Med Screen, 16(4), 199-20.

Women’s Equality Party, UK (2019). Public Cervix Announcement. Retrieved from:

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