Attitudes to screening for cervical cancer: a population-based study in Sweden

Objectives: To investigate how attitudes and beliefs about Pap smear screen ing affect women's choice to participate in organized or opportunistic scre ening. Methods: Telephone interviews were conducted with 430 (69.0%) non-attenders and 514 (80.7%) attenders to Pap smear screening, sampled from a populatio n-based database. The interviews were conducted during 1998 in Uppsala Coun ty, Sweden. Main outcome measure: odds ratios (OR) and 95% confidence inter vals (CI). Results: Non-attendance was negatively associated with perceived severity o f cervical cancer compared to other malignancies (OR = 1.9, 95% CI 1.1-3.4) as well as with satisfactory benefits (OR = 0.7, 95% CI 0.6-0.8), but posi tively associated with time-consuming and economical barriers (OR = 1.2, 95 % CI 1.1-1.5 and OR = 1.7, 95% CI 1.2-2.5, respectively). Non-attendance wa s also negatively associated with anxiety, but was of borderline significan ce (OR = 0.9, 95% CI 0.8-1.0). The results were strengthened with increasin g time since last smear or if self-reported attendance status was used inst ead of true attendance. Non-attenders kept holding harder to their preferen ces than did attenders, stating they would not participate if their prefere nces were not met. Conclusions: Important differences in attitudes and beliefs exist between n on-attenders and attenders in Pap smear screening. Rather than being emotio nal, the main barriers are either practical or rooted in misunderstandings and lack of relevant information. These insights offer opportunities to inc rease attendance rates considerably.