Some women in the UK still unaware of cervical screening

"Nearly a quarter of women who don't make cervical screening appointments are unaware that the process even exists, according to a UK survey," BBC News reports.

Cervical cancer is a type of cancer that starts in the cervix, the entrance to the womb. It's responsible for around 900 deaths a year in the UK.

Regular screening appointments to check for abnormal cell growth are offered to all women aged between 25 and 64.

This study found about a quarter of eligible women didn't go for a cervical screening test. Most women who didn't attend either said they were unaware of screening or that they intended to go, but were overdue for their appointment.

Cervical cancer became a high-profile media topic after the untimely death of reality TV star Jade Goody from the disease in 2009. It now seems that almost a decade later, the issue has dropped off the radar for many women.

The researchers suggest that interventions to increase the uptake of cervical screening should focus on three main types of non-participants:

• those who intend to go to screening but don't actually confirm an appointment
• those unaware of screening
• those who actively decide not to be screened

Read more about cervical cancer screening, including why it's offered and who's invited for a screening test.

Where did the story come from?

The study was carried out by researchers from University College London (UCL) in the UK and the National Cancer Institute in the US.

It was funded by a grant from Cancer Research UK.

The study was published in the peer-reviewed European Journal of Cancer. It's available on an open access basis and is free to read online.

BBC News' coverage was balanced and accurate.

What kind of research was this?

This cross-sectional study wanted to assess the prevalence of women who didn't participate in the UK cervical cancer screening programme, and better understand the reasons why they didn't attend.

Cervical screening is used to detect any abnormal changes in cells in the cervix that could potentially develop into cervical cancer.

All women between the ages of 25 and 64 who are registered with a GP are invited for cervical screening.

But the uptake of cervical screening has been decreasing in the UK. The researchers wanted to investigate the reasons behind the fall in attendance.

Cross-sectional studies are useful for analysing data from a population at a specific point in time. But a drawback is that they can't confirm the cause for any observations or explore which factors could be having an influence.

What did the research involve?

Researchers surveyed 3,113 women eligible for screening in the UK using face-to-face computer-assisted personal interviews (CAPIs).

Four questions were asked around past screening behaviour and whether the women intended to attend screening in the future.

The questions were:

• Have you ever heard of cervical screening, also known as the smear test or Pap test?
• Have you ever had a cervical screening test?
• When was the last time you had a cervical screening test?
• Do you intend to go when next invited?

From their responses, the women were categorised as either participants or non-participants.

Non-participants were classified as:

• unaware
• unengaged
• undecided
• decided not to be screened
• intending to be screened

Data was also collected on sociodemographic characteristics, such as:

• age
• marital status
• number and age of children
• occupational status
• ethnicity
• first language spoken

What were the basic results?

Of the 3,113 women, 793 (27%) were classed as non-participants:

• 219 women (28%) were unaware of screening
• 406 women (51%) were overdue for screening but intended to be screened
• 118 women (15%) had decided not to be screened

Women between the ages of 25 and 34 were more likely to be classed as non-participants. They were also the most likely age group to be unaware of screening. Women aged 55-64 were most likely to have decided against screening.

Women from lower socioeconomic groups and who didn't work were more likely to be unaware of screening, overdue for screening, or to have decided against screening.

Single women were more likely to be unaware or to have decided not to be screened compared with married women.

Women from ethnic minority groups were more likely to be unaware of screening. But South Asian and black women were more likely to intend to go to screening than white British women.

When language was adjusted for, there was no difference between white British women and those from different ethnic backgrounds.

How did the researchers interpret the results?

The researchers concluded that, "This work suggests that the vast majority of women in Britain who are not participating in cervical screening as recommended are not making an active decision not to attend.

"Most non-participants are either unaware or would like to be screened but are unable to translate their positive intentions to be screened into action." 

Conclusion

This study presents interesting findings on the proportion of women who don't go for cervical screening tests, and the possible reasons for their non-attendance.

Researchers found most non-participants were either unaware of screening or intended to go to screening but still failed to go. This was most common in single women aged 25-34.

One point to note is that the data was collected through self-reported questionnaires, which carry the risk of inaccurate reporting because of the perceived social stigma around screening and the desire to give the "right" response.

In the case of cervical cancer screening, it's possible women know they should attend screening but for whatever reasons don't want to attend, but feel more comfortable saying that they do in fact plan to attend screening, even when they might not in reality.

Another point is that women who agree to participate in market research screening interviews may be from different socio-demographic groups to those who don't.

This means we can't be completely sure that this sample – despite being large – represents the views and screening participation of the population as a whole. 

The researchers suggest that this study will help focus interventions on three main types of non-participants to increase the uptake of cervical screening:

• those who intend to go to screening but are overdue for the test
• those unaware of screening
• those who actively decide not to be screened

This incredibly useful study highlights the need for further exploration into the reasons why some women don't go for cervical screening – what is the exact reason women are unaware of screening, and why do they choose not to attend?

These questions are important, as cervical cancer is often preventable if abnormal cell changes are detected early.

In England, screening is offered to all women aged 25-64. Teenage girls aged 12-13 are offered the HPV vaccine, which helps protect against cervical cancer, as part of the routine NHS childhood vaccination schedule.