Can brief, low-cost interventions help to increase cervical cancer screening rates?

In a blog for World Cancer Day, Sarah Wilding, Mark Conner and Daryl O’Connor discuss their study aiming to increase cervical cancer screening uptake in Yorkshire, registered at the ISRCTN registry.

Each year, about 3,200 women are diagnosed with cervical cancer in the UK – that’s just over 8 women per day. It’s also the fourth most common cancer to occur in women worldwide and the most common cancer in women aged under 35.

One of the best ways to prevent cervical cancer from developing is through regular screening. In the UK, women and eligible individuals are invited to attend screening every 3 years between the ages of 25 and 49 and every 5 years between the ages of 50 and 65.

Cervical cancer screening aims to detect abnormal changes in the cervix. To do this, a nurse takes a sample of cells from the cervix using a small soft brush. This sample is then sent off to the lab to test for a virus called high-risk human papillomavirus (HPV). HPV can cause cells in the cervix to change and can lead to cancer.

Even though screening is one of the best ways to stop cervical cancer from developing, the percentage of people attending screening is decreasing year on year. The most recent statistics suggest that around 7 in every 10 of the individuals invited for screening actually go on to attend. Women from poorer areas as well as those from ethnic minority backgrounds are less likely to go for screening.

Reasons for not attending screening

There are a lot of things that can get in the way of going for cervical cancer screening. Not having enough time to go for screening, as well as thinking that it will be painful, uncomfortable or embarrassing are some of the most commonly reported barriers.

Women tend to be more likely to get screened if they can easily make an appointment, along with thinking that screening will give them peace of mind, as well as seeing screening as potentially lifesaving.

Our study

Our study, which is funded by Yorkshire Cancer Research, focuses on just under 15,000 women from Yorkshire, Humber and the Northeast of England who were invited to attend cervical cancer screening in December 2021. We used the cervical screening service to mail out some extra materials to these women and will look at whether receiving these makes women more likely to make an appointment for screening up until April 2022.

Research shows that if people can spot situations that might stop them from getting screened and then link them with solutions to overcome these, they are more likely to go for screening. Part of our intervention involves sending a screening plan for some participants to complete. The screening plan provides set situations and solutions which we’ve developed based on past research to help participants work out which are most relevant for them (e.g., “When I receive my cervical cancer screening letter, I will think about the benefits of getting screened”).

Research also suggests that people tend to underestimate how many people like them go for screening, and this can put them off attending. Providing more accurate information (e.g., that over 70% of women go for screening) may encourage more women to make an appointment to get screened.

We recently tested both of these interventions in bowel cancer screening and found that combining the information about how many other people go for screening with the screening plan increased the likelihood of people aged 60-64 completing their screening test kit.

Why is this important?

With cervical screening rates continuing to decline, particularly in women from poorer areas, it’s important to develop simple and cost-effective ways of encouraging screening attendance. The interventions we have developed are very brief, simple, and could easily be incorporated into the routine mailing of screening invitations and reminders.

We’ve worked with the cervical screening service to send out the materials and will be using data from them to see how our interventions have impacted screening uptake. We’ll also be looking to see whether there are any differences in our intervention effectiveness in younger versus older women and in higher and lower-income areas.

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