Reasons Women Do Not Attend Screening for Cervical Cancer: A Population-Based Study in Sweden

Background. With an improved compliance with screening a larger reduction of cervical cancer incidence would be within reach. We aimed at investigating why certain women do not attend Pap smear screening and at validating the reliability of self-reported screening. Methods. In 1998 in the county of Uppsala, Sweden, information was collected through telephone interviews with 430 nonattendees and 514 attendees to Pap smear screening, who were all sampled from a population-based database. The womenʹs recall of attendance was validated against the database. The main outcome measures used were odds ratios (OR) and 95% confidence intervals (CI). Results. Non-attendance was positively associated with nonuse of oral contraceptives (OR = 3.56, 95% CI 2.18–5.83), seeing different gynecologists (OR = 1.90, 95% CI 1.34–2.70), and seeing a physician very often (OR = 3.12, 95% CI 1.45–6.70) or not at all (OR = 1.78, 95% CI 1.09–2.90). Frequent condom use (OR = 1.88, 95% CI 1.02–3.47), living in rural/semirural areas (OR = 1.55, 95% CI 1.07–2.21), and not knowing the recommended screening interval (OR = 2.16, 95% CI 1.20–3.89) were all associated with nonattendance, whereas socioeconomic status was not, when tested in a multivariate model. Among the nonattendees, 57% underestimated the time lapse since last smear. Conclusions. Seeing a gynecologist on a regular basis and information guiding women to have a Pap smear on their own initiative are important factors for recurrent screening. Therefore, information should be given to all women about the purpose and benefits of Pap smear testing. Self-reports on screening should be treated with caution.