Elsevier

Preventive Medicine

Volume 64, July 2014, Pages 108-113
Preventive Medicine

Reasons for non-attendance to cervical screening and preferences for HPV self-sampling in Dutch women

https://doi.org/10.1016/j.ypmed.2014.04.011Get rights and content

Highlights

  • We investigated the reasons for non-attendance in the cervical screening programme.

  • We investigated why these women do or do not accept HPV self-sampling devices.

  • A large cohort of 10,166 women returned a questionnaire.

  • Organisational barriers are the main reasons for non-attendance.

  • Convenience and self-control are important reasons to use a self-sampling device.

Abstract

Objectives

High attendance rates in cervical screening are essential for effective cancer prevention. Offering HPV self-sampling to non-responders increases participation rates. The objectives of this study were to determine why non-responders do not attend regular screening, and why they do or do not participate when offered a self-sampling device.

Methods

A questionnaire study was conducted in the Netherlands from October 2011 to December 2012. A total of 35,477 non-responders were invited to participate in an HPV self-sampling study; 5347 women did opt out. Finally, 30,130 women received a questionnaire and self-sampling device.

Results

The analysis was based on 9484 returned questionnaires (31.5%) with a self-sample specimen, and 682 (2.3%) without. Among women who returned both, the main reason for non-attendance to cervical screening was that they forgot to schedule an appointment (3068; 32.3%). The most important reason to use the self-sampling device was the opportunity to take a sample in their own time-setting (4763; 50.2%). A total of 30.9% of the women who did not use the self-sampling device preferred after all to have a cervical smear taken instead.

Conclusions

Organisational barriers are the main reason for non-attendance in regular cervical screening. Important reasons for non-responders to the regular screening to use a self-sampling device are convenience and self-control.

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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