The recommended interval for cervical cancer screening: Victorian women's attitudes to an extended interval

Scalzo, Katherine; Mullins, Robyn

doi:10.1111/1753-6405.12340

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…16 Underscreened women were more accepting of reduced screening frequency (82.5%, P < .05), which may be attributed to the fact that the NCSP now aligns with their existing screening behaviours. 17 Self-sampling acceptability (60.9%) was comparable to a previous study (57.2%). 8 The new program anticipates that self-sampling will overcome some of the barriers to traditional cervical screening.…”

Section: Knowledge and Acceptance Of New Guidelinessupporting

confidence: 79%

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Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program

Nagendiram

Bidgood

Banks

et al. 2020

Health Prom J of Aust

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Australia may be the first country to eliminate cervical cancer as a public health issue due to its longstanding National Cervical Screening Program (NCSP) and the early introduction of the Gardasil vaccine for Human Papillomavirus (HPV) into the National Immunisation Program Schedule. 1 In December 2017, Australia updated the NCSP by replacing bi-annual pap smears with a 5-yearly Cervical Screening Test (CST) for Human Papillomavirus (HPV). 2,3 Women now commence cervical screening at 25 years old. This delay in screening is to prevent the overscreening and overinvestigation of young women as cervical screening has not reduced the incidence or mortality rate from cervical cancer in women under 25 since the introduction of the NCSP in Australia. Furthermore, the new NCSP incorporates the opportunity for self-sampling among eligible women. Women over 30, who are under-and never screened, can be offered a self-collected high vaginal swab instead of a traditional pap smear. 2 As the new NCSP was implemented 2 years ago, there is minimal research regarding Australian women's awareness and attitudes towards the new guidelines. A recent survey by the Australian Cervical Cancer Foundation (ACCF) identified that only 23% of women were aware that the CST should be performed every 5 years. 4 A study of

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Section: Knowledge and Acceptance Of New Guidelinessupporting

confidence: 79%

“…However, they were still concerned at the potential implications of reduced screening for women's health 16 . Underscreened women were more accepting of reduced screening frequency (82.5%, P < .05), which may be attributed to the fact that the NCSP now aligns with their existing screening behaviours 17 …”

Section: Discussionmentioning

confidence: 99%

Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program

Nagendiram

Bidgood

Banks

et al. 2020

Health Prom J of Aust

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“…Previous studies conducted in Australia prior to the announcement of the changes have identified women’s concerns about age of first invitation to screen, screening intervals and cost-cutting, so these issues could have been addressed in advance through better communication. 32–34 A potential for cancer to be missed and a suspicion that an increased screening interval was related to cost were major concerns for women described in these publications, and are concerns shared by many commenters in our study. Internationally, publications similarly report that while HPV testing is generally accepted by women, longer screening intervals face opposition.…”

Section: Discussionmentioning

confidence: 66%

‘It has saved thousands of lives, so why change it?’ Content analysis of objections to cervical screening programme changes in Australia

et al. 2018

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ObjectivesThe incidence and mortality of cervical cancer have halved since introduction of the Australian cervical screening programme in 1991, involving 2-yearly Pap smears from ages 18–69 years. In 2017, the programme changed to 5- yearly primary human papillomavirus (HPV) testing for women aged 25–74 years. This study investigated reasons for opposition to the renewed screening programme within the open-ended comments of an online petition, ‘Stop May 1st Changes to Pap Smears—Save Women’s Lives’, opposing the changes, which received over 70 000 signatures and almost 20 000 comments.MethodsContent analysis of a random sample of 2000 comments, reflecting 10% of the 19 633 comments posted in February–March 2017.ResultsNineteen codes were identified, reflecting four themes: (1) valuing women’s health and rights, (2) political statements, (3) concerns about healthcare funding cuts and (4) opposition to specific components of the new screening programme. The most prevalent codes were: placing value on women’s health (33%), concerns about increasing screening intervals (17%) and opposition to the changes related to personal experiences with cervical cancer or cervical abnormalities (15%). Concern about the key change in technology (HPV testing instead of Pap smears) was expressed in less than 3% of comments, and some opposition to the changes from health professionals was noted.ConclusionsScreening changes within this selected group were perceived as threatening women’s health, as a political policy created by male decision-makers and as a cost-cutting exercise. Many commenters were concerned about increased screening intervals and later screening onset, but little opposition was expressed regarding the testing technology itself. This analysis may inform public education and communication strategies for future changes to cervical screening programmes internationally, to pre-emptively address specific concerns about the changes.

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“…The interviews followed a topic guide developed using existing literature on previous work about health professionals’ attitudes towards these changes prior to implementation 8,13,16 . The topic guide covered attitudes and expectations pre‐ and post‐implementation of the renewed program, barriers/facilitators to program implementation, clinical practice implications related to the changes, communication of test results, and resources for understanding the changes (Box 1).…”

Section: Methodsmentioning

confidence: 99%

“…Public resistance to changes in the NCSP has been reported, with concerns mainly focused around the extended screening interval 5,6 . Studies conducted prior to the renewal also highlighted health provider recommendation as an important component of women’s acceptance of extended screening intervals 7–9 . Around 80% of cervical screening tests in Australia are performed by general practitioners (GPs) 10 and thus they are likely to play a major role in women’s understanding and experience of the renewed NCSP.…”

Section: Introductionmentioning

confidence: 99%

Implementing changes to cervical screening: A qualitative study with health professionals

Dodd

Obermair

McCaffery

2020

Aust NZ J Obst Gynaeco

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Background: Profound changes were made to the Australian National Cervical Screening Program in December 2017, which included a reduction in the frequency of screening and a new cervical screening test. Aim: To explore the attitudes and experiences of health professionals practising in Australia since implementation of these changes. Materials and Methods: Thirty-one semi-structured interviews were conducted with general practitioners, obstetricians and gynaecologists, pathologists and nurses involved in cervical screening Australia-wide. Data were analysed using Framework Analysis. Results: Overall, health professionals had positive attitudes toward the changes but described many challenges associated with their implementation. Participants discussed practical system challenges, communication and education, finding ways around the guidelines and other perceived 'collateral'. Practical system challenges included increased colposcopy referrals, limited access to the National Cancer Screening Register, a complex primary screening approach, and issues with selfcollection. In terms of communication and education, limited public education was recognised, in addition to challenges with particular age groups of women. Finding ways around the guidelines were described, for example over-referring women for co-testing by stating symptoms, which could lead to overtreatment. Other perceived collateral were demonstrated through reduced opportunistic screening opportunities due to less frequent primary care presentations, and concern over the potential for further underscreening in already under-screened populations. Conclusions: These findings provide insight into the challenges health professionals face with renewing programs, in terms of practical issues and unexpected downstream effects which need to be addressed to ensure future implementation of the program is streamlined.

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The recommended interval for cervical cancer screening: Victorian women's attitudes to an extended interval

Cited by 9 publications

References 11 publications

Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program

Women's attitudes and understanding of cervical cancer and the new National Cervical Screening Program

‘It has saved thousands of lives, so why change it?’ Content analysis of objections to cervical screening programme changes in Australia

Implementing changes to cervical screening: A qualitative study with health professionals

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