Studies of Response to Cervical Screening

Study of Women who DID not Respond to Screening for Cervical Cancer

Demographic and social factors influencing the population response to cervical screening programs have been studied. Age, marital status and, to a lesser extent, place of birth and socio-economic status were the most relevant factors. On the other hand, the reasons for nonparticipation were mainly the lack of information and motivation. Personal invitations, the recall of women who did not present on the first call, and the setting up of decentralized smear collection clinics proved to be useful tools to increase attendance.

Cervical-cancer screening: attendance and cost-effectiveness

The influence of attendance on the health effects and cost-effectiveness of cervical-cancer screening was studied, both for organized screening programmes and for spontaneous screening. The asymmetric distribution of smears among the female population and the higher risk incurred by women who never or only occasionally attend screening appear crucial in determining the health effects of screening. An increase in attendance rate induces a substantial rise in health effects and a less than proportionate rise in costs, thus improving cost-effectiveness. Wider screening coverage, in order to increase the number of life-years saved, is achieved more efficiently by encouraging a greater number of women to attend than by inviting the same number of women to attend more often, i.e., with a shorter interval between successive screens. Spontaneous screening is characterized by high coverage for younger women and low coverage for middle-aged and older women. This leads to a small amount of health effects and poor cost-effectiveness as compared with organized screening.

Attendance for cervical screening--whose problem?

Despite the existence of an effective screening technique for cancer of the cervix, incidence and mortality from this disease have not declined in the United Kingdom. The basic problem is that women most at risk of the disease are under-represented in the screened population. The evidence for two different points of view to explain this situation is examined. These viewpoints are the failure of the women to attend, and the failure of the service to meet the needs of women. This paper argues that the evidence supports the view that the organisation of the existing screening service impedes the maximum participation of at-risk women. We discuss the features that an effective service needs to incorporate, and put forward principles for the development of a more effective screening system, namely, that it should be provider-initiated and user-oriented.

Young people's knowledge of the cervical smear test

A sample of three hundred and forty-eight 16 and 17-year-old students (120 boys and 228 girls) on a range of vocational courses were asked a number of questions about the cervical smear test in October 1980. 10% of the boys and 27% of the girls selected "smear" as a word they would associate with cancer, but only 3.3% of the boys and 9.2% of the girls mentioned the cervical smear test as a preventive measure. Approximately a quarter of the students considered cervical cancer to be usually curable with early treatment, and the majority considered it to be rarely curable with late treatment. 38% of the boys and 64% of the girls had heard of the cervical smear test and the doctor, clinic, family planning clinic and hospital were suggested as places where the smear is available. 9% of the girls said they had had a smear test. These results were used as a baseline for the designing of suitable teaching material.