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Opinion: Why are some women avoiding cervical cancer screening?

Fear of cancer appears to influence some women’s decision to attend cervical screening – but not in the way you might think, writes health psychologist Marie Kotzur.

Marie Kotzur

WHEN I TELL people what I study, the men flinch and some of the women look away. So now that you know what’s expected of you, here you go: I’m doing research for a doctoral
degree in health psychology. In detail, I’m looking at why some women go for cervical
cancer screening and others won’t.

Ready to read on? When you’re doing a PhD, you have to get used to the question “How did you choose that topic?” Or maybe it’s just my topic…

Worldwide, cervical cancer is the second most common cancer that women can get. The National Cancer Registry reports that 98 women die from cervical cancer every year—most before their 65th birthday. While the incidence of invasive cervical cancer has remained stable over the past 20 years, the incidence of pre-cancer has almost tripled since 1994.

But all is not lost. In 2008 the National Cervical Screening Programme (NCSP) began sending invitation letters for free cervical cancer screening to women aged 25 to 60 years. Women in this age group are most at risk of developing abnormal cervical cells that might develop into cancer. You can’t feel abnormal cervical cells. They will only cause symptoms when the cancer has already developed. But cervical cancer screening uses the Pap test to find abnormal cells before they turn into cancer. Women with abnormal cells are referred for treatment and cancer is prevented.

But when I started my research in 2010 the picture wasn’t too promising. Irish research at the time, found screening rates at under 20%. At the same time incidence was rising and age at diagnosis was sinking, according to the Health Information and Quality Authority and the Irish Cancer Society. The Irish Cancer Society was speaking of a “serious cervical cancer problem.”

Pap test screening can reduce cervical cancer rates by 80%, but for that the NCSP also has to screen 80% of eligible women. In 2013 the NCSP achieved a screening rate of 74%. That’s good news, but we can do better.

In my first study I interviewed women about their experience of cervical screening. They thought it was great stuff. Sure, they had trouble making time for it sometimes and it wasn’t the most pleasant thing they’d ever done, to put it in their words though: “… it is uncomfortable for what? 30 seconds? Sure and then it’s reassurance for three years…”

But that may have just been the ladies I spoke to, so I followed this up with a survey of women across the country. Most of them said they had been for cervical screening, which was great. They also really appreciated it and most of them said they would go again next time they were invited. Yet, a lot of them didn’t seem to know much about cervical screening.

I did a statistical comparison of women who had been tested and women who hadn’t. That showed that women who hadn’t were younger, were more afraid of cervical cancer, but found more obstacles to screening and had weaker intentions to go in the future. I also compared women with strong and weak intentions to go screening: women with stronger intentions, primarily held more positive attitudes towards cervical screening.

“What a finding!” I hear you say. “Women who think cervical cancer screening is a good thing are more likely to say they will have it done in the future. Go science!” I know… The strange thing is, after all the stuff I told you in the first few paragraphs, you probably think cervical screening is a good thing. Well, women who knew this stuff were not more likely to say they would get screened in the future. All the information made no difference to their intentions.

Therefore, I’m now running a study to see what makes a difference. Since the younger women were less likely to get screened, I’m focusing on 23- and 24-year-old ladies, who are about to be invited for cervical screening. If you’re that age, you might like to tell me your opinion—and you can be as honest as you like: the study is completely anonymous.

I just want to understand how women think about cervical screening. It takes only 15 minutes (maybe less) and there’s a prize draw attached, too. All that’s involved is some questions, a video to watch or some reading material, and some more questions. All of the study is done online at Cervical Screening Study. Follow the link for more information, too.

Marie Kotzur is a doctoral student at the School of Applied Psychology at University College Cork.

Read: Rates of breast cancer, invasive cervical cancer and prostate cancer are increasing in Ireland

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