Why do women miss cervical screening appointments? by Dr Rebecca Richards


Recent data shows that currently, 1 in 4 women fail to attend their cervical screening appointments in the UK (NHS, 2018) (‘non-attenders’ in this blog). It’s important that we understand why these women fail to attend their screening appointments in order to design interventions to increase uptake. In today’s blog, I’d like to share the findings of a novel two-part study which has advanced our knowledge.


The first part was conducted at University College London in 2017 and was a survey of 3,331 women in the UK aged 25 to 64 (Marlow, Chorley, Haddrell, Ferrer & Waller, 2017). Importantly, this study identified three main types of non-attenders: Of the 793 women that were identified as non-attenders in this sample (see Figure 1):

- 51% reported that they intended to be screened but were overdue (type 1);

- 28% were unaware of screening (type 2); and

- 15% had made an active decision not to attend (type 3).

A further 3% were classified as unengaged and 2% as undecided but these groups were considered too small to constitute further ‘types’.


Figure 1 Reason for non-attendance in sample of 793 women in the UK

This study also found that:

1) women who intended to be screened but were overdue (type 1) were more likely to be 25-35 years old, single and from a lower social grade;

2) women who were unaware of screening (type 2) were more likely to be younger and from lower social grade/and or ethnic minority background; and

3) women who actively decided not to attend (type 3) were more likely to be older and had been screened before.


The second part of the study explored the self-reported barriers to screening for the women who had made an active decision not to attend (type 3), compared to those who intended to be screened but were overdue (type 2) (Bennett et al., 2018). Table 1 shows the barriers endorsed by the two types of non-attenders. The most frequently endorsed barriers by both types were being ‘too busy for screening’ (16%), low relevance due to sexual behaviour (15%), and embarrassment (12%).


Table 1 Details of barriers by Type 1 ("intenders") and Type 3 ("decliners")

Further analysis identified that type 3 non-attenders were more likely to feel they were:

- ‘too old to go for screening’ (9% vs 3%); or

- have ‘more important things to worry about’ (12% vs 2%); or

- had a ‘bad experience of screening in the past’ (14% vs 7%); or

- had ‘weighed up the risks and benefits and decided it’s not worth going’ (13% vs 1%), ...compared to type 1 non-attenders.

These findings are unsurprising given that the first part of this study found that women who were categorised as type 3 non-attenders were more likely to be older women and had been screened before.


The barriers endorsed by both types of non-attenders indicate several areas for intervention:


1. We need to do more to inform women of their personal risk of cervical cancer, especially that their risk is not necessarily reflected by their current sexual behaviour or age. This in turn, will likely help to increase the perceived value and importance of cervical screening.


2. We need to reduce the embarrassment felt by many women when attending screening appointments and make women feel comfortable and confident to attend.


3. Different interventions may be useful for different groups of women, including younger vs older women, women of a low vs high social grade and those of a majority vs minority ethnic background.


Finally, it is worth noting that 28% of this sample of women were unaware of screening. This number is unacceptable - cervical cancer is preventable. Targeted awareness-raising campaigns are needed, in order to reach this significant number of women who are unaware of screening, if we aim to eradicate cervical cancer during our generation.

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All views and opinions are my own.


References

Bennett, K. F., Waller, J., Chorley, A. J., Ferrer, R. A., Haddrell, J. B., & Marlow, L. A. (2018). Barriers to cervical screening and interest in self-sampling among women who actively decline screening. Journal of Medical Screening, 25(4), 211-217. doi:10.1177/0969141318767471.

NHS. (2018). One in three women don’t attend cervical screening because of ‘embarassment’. Retrieved from: https://www.nhs.uk/news/cancer/one-three-women-dont-attend-cervical-screening-because-embarrassment/

Marlow, L. A., Chorley, A. J., 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.

Cancer Research UK
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