Reasons for non-attendance to cervical screening and preferences for HPV self-sampling in Dutch women
Introduction
Screening programmes are only effective if a substantial part of the target population is screened (Bekkers et al., 2006). The coverage of all European cervical screening programmes is below 80%, ranging from 10% to 79%. In only five regions (France, England, Finland, the Netherlands and Sweden) the coverage was 70% or more (Anttila et al., 2009). Women not participating in the cervical screening programme, called ‘non-responders’, are at increased risk of cervical cancer (Peto et al., 2004, Sasieni et al., 2003).
It is commonly assumed that high-risk human papillomavirus (hrHPV) testing on clinician-collected cervical samples provides better protection against cervical cancer than cytology (Bosgraaf et al., 2014, Snijders et al., 2013), given its higher sensitivity for detecting cervical intraepithelial neoplasia grade 2 or worse (Arbyn et al., 2012, Rijkaart et al., 2012, Ronco et al., 2010). Therefore, many developed countries will probably convert from cytology to primary HPV testing. Furthermore, hrHPV DNA testing on self-sampled cervicovaginal material (HPV self-sampling) has similar sensitivity for detecting high-grade CIN as hrHPV DNA testing on clinician-collected material, provided that a combination of a clinically validated self-sampling device and ditto HPV test is used (Arbyn et al., 2014, Meijer et al., 2009, Schmeink et al., 2011). Offering self-sampling for hrHPV DNA testing has proven to be an effective screening method for women who do not attend regular cervical screening programmes; one third return the self-sampling device, thereby increasing the attendance rate of the screening programme significantly (Bais et al., 2007, Gok et al., 2010, Gok et al., 2012, Snijders et al., 2013, Verhoef et al., 2014).
The aims of the study were to determine non-responders' reasons not to attend regular cervical screening, and why these non-responding women do or do not participate when offered a self-sampling device. This study is the first to report on women's reasons to participate neither in the regular screening programme nor in a self-sampling programme. This information may provide opportunities to increase screening coverage.
Section snippets
Methods
In the Netherlands, cervical cancer screening started in the early 1970s. Since the subsequent restructuring of the Dutch screening programme in 1988 and 1996, there has been a nationwide programme targeting women aged 30–60 years. Those women are invited at 5-year intervals for cervical smears, often taken by their general practitioner or practice assistants(Bosgraaf et al., 2013, Rebolj et al., 2007). The Dutch screening programme has contributed to a reduction in morbidity and mortality of
Results
A total of 10,027 out of 30,130 women (33.3%) returned a self-sampling device, of whom 9484 women also returned a questionnaire (group 1), and 543 only returned a self-sample specimen without a questionnaire (group 2). A total of 20,130 women did not return a self-sampling device, of whom 682 women did return a questionnaire (group 3). These groups are shown in Fig. 1. Overall, 10,166 questionnaires were returned. Response rates per age group (groups 1 and 3) are shown in Table 1.
Discussion
The main reason for non-attendance in the Dutch regular cervical screening programme, for women who returned the questionnaires, was that women forgot to schedule an appointment to have a cervical smear taken. This was the most given answer for both women who did (group 1) and did not (group 3) return a self-sampling device along with the questionnaire. Furthermore, the women in group 1 felt too embarrassed to have a cervical smear taken by the physician. Among the women in group 3, the second
Conflict of interest statement
The authors declare that there are no conflicts of interest.
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