One in three women don't attend cervical screening because of 'embarrassment'

Monday January 22 2018

"Embarrassment makes women avoid smear tests, charity says," reports BBC News. This follows a survey by the charity Jo's Cervical Cancer Trust of more than 2,000 women in the UK, half of whom either delayed or didn't attend screening.

More than 3,200 women are diagnosed with cervical cancer every year in the UK, and nearly 900 die annually. All women aged 25 to 49 are invited for a screening test every 3 years, while those aged 50 to 64 are invited every 5 years.

But 1 in 4 women skip the cervical screening, with the proportion increasing to 1 in 3 among those aged 25 to 29 and to 1 in 2 in some more deprived regions of the UK.

The survey shows that embarrassment about body shape is a barrier to attendance for between a third and half of women. It also highlights a lack of understanding about the importance of screening, with a quarter saying they didn't think they needed to go because they were healthy and more than a third believing screening doesn't reduce your cancer risk.

The findings highlight the need for better access to screening services for some women, but also for improved awareness and education about the vital role of screening in cancer prevention.

If you find the thought of attending a cervical screening distressing, you do have the option of asking in advance for a female doctor or nurse to carry out the 5-minute test.

Read more about cervical screening.

Who conducted the research?

The survey was carried out by Jo's Cervical Cancer Trust, the only UK charity dedicated to women affected by cervical cancer and cervical abnormalities. It aims to improve cervical cancer prevention and treatment, and so reduce the impact on women and their families.

Cervical screening offers the greatest protection against cervical cancer. NHS England's Five Year Forward View calls for a "radical upgrade in prevention", and cervical screening is the best way to achieve this.

However, data showed that in 2016-17 in the UK, more than 1.2 million women – around 1 in 4 of those eligible – didn't take up their screening invitation. And this figure increased to 1 in 3 when looking at 25- to 29-year-olds.

Aside from the vital goal of saving lives, screening for cervical cancer helps save the NHS money. Jo's Cervical Cancer Trust estimates that treating early-stage cervical cancer is around 14 times less expensive then treating later-stage cervical cancer.

How was the survey carried out?

Currently, only a brief press release from the charity is available, so information on the methods is limited.

The charity said it surveyed 2,017 women. Just under half of these (933) either did not attend screening (300), delayed screening (484) or were currently delaying screening (149).

However, how these women were recruited or how representative they were of women across the UK, particularly of different age and socio-economic groups, is unclear.

What did they find?

Understanding of cervical cancer and screening

  • 61% of women aged 25 to 35 were unaware they were in the highest-risk group for cervical cancer
  • 37% thought screening did not reduce your risk of disease
  • 24% thought they were not at risk because they were healthy
  • 17% thought smears were important but didn't know why (35% of non-attenders)
  • 11% thought you didn't need a smear if you'd had the HPV vaccine

Why women don't attend

  • 35% of all women reported being embarrassed to attend because of their body shape (50% of non-attenders), 34% had concerns over the appearance of the vulva (48% of non-attenders) and 38% were concerned about whether they smelled "normal" (54% of non-attenders)
  • 31% said they wouldn't go if they hadn't shaved or waxed their bikini area
  • 35% wouldn't go if they had to take time off work, 16% wouldn't miss the gym to attend and 14% would rather miss a smear than a waxing appointment
  • 26% said it's too hard to make an appointment
  • 20% would rather not know if something was wrong (34% of non-attenders)
  • 30% of those who had never had a smear said they didn't know where to get the test

Yet despite these findings, nearly all women (94%) said they would have a free test to prevent cancer if it was available, highlighting a lack of understanding about the role of screening.

What did the experts say?

Several experts have spoken to reassure women about cervical screening.

Robert Music, chief executive of Jo's Cervical Cancer Trust, said: "Smear tests prevent 75% of cervical cancers, so it is a big worry that so many young women, those who are most at risk of the disease, are unaware of the importance of attending. It is of further concern that body worries are contributing to non-attendance.

"Please don't let unhappiness or uncertainty about your body stop you from attending what could be a life-saving test. Nurses are professionals who carry out millions of tests every year – they can play a big part in ensuring women are comfortable," he added.

Jilly Goodfellow – senior sister and nurse practitioner at Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust – said: "Nurses who take smears see hundreds of women but should never forget that the procedure may be embarrassing for some. We know that if a woman does not have an acceptable experience, this may put her off having smears in the future, and the biggest risk of developing cervical cancer is not having a smear.

"The nurse's focus is to make women feel welcome, comfortable and ensure their dignity is maintained, while obtaining a good sample. We do this by talking to the woman while she is fully dressed so she is aware of what is going to happen, [and explaining] reasons for the smear, when she will receive the result and what it will mean.

"A chaperone is always offered, and if they would like a friend or partner with them, this is fine too. The majority of sample-takers are female nurses who fully understand what it is like to expose the most intimate part of their body to a complete stranger."

What else is being done?

Jo's Cervical Cancer Trust has published an additional report called 'Cervical screening in the spotlight'. This is the second of two audits looking at what the local authorities responsible for commissioning sexual health services have been doing to increase screening uptake and understand any barriers.

Among the report's recommendations are a plan for increased funding for cervical screening to improve availability of services to all women, and a national campaign to improve awareness about cervical cancer, the need for screening and HPV vaccination, starting with improved education at school level.

Analysis by Bazian
Edited by NHS Website