Women distrust risk-based cervical cancer screening

All the cost-effectiveness analyses in the world may not sway women from their belief that their health is best served by annual Pap tests rather than risk-based cervical cancer screening, a new study suggests. Many even think less frequent screening is a maneuver to save health plans money.

The US Preventive Services Task Force and the Canadian Task Force suggest that low-risk women can safely be screened for cervical cancer every 3 years after three consecutive normal Pap smear results. To gauge women’s willingness to switch to risk-based screening, Dr. Linda French and colleagues at Michigan State University in East Lansing conducted focus group interviews to assess the attitudes, beliefs and perceived barriers to this approach. According to their report in the November/December Annals of Family Medicine, their study included eight groups of 4 to 21 women each from diverse backgrounds.”Women were very uncomfortable with the idea of not having cervical cytology at an annual interval,” Dr. French told Reuters Health. “They view annual screening as an established way of protecting their health and mistrust the idea of less frequent intervals.”The authors found these strong beliefs were based on “fear of rapid disease progression, worry about inaccuracy of Pap smears, an appreciation of the decrease in death rates from cervical cancer associated with increases in Pap testing, and a strong conviction that obtaining Pap smears was doing something important for one’s health and one’s family,” they write The participants were also suspicious of the motivations behind risk-based cervical cancer screening, considering it a ruse by organized medicine and the insurance industry to save money.Many of their feelings were based on personal experience with other people whose advanced cancers had not been detected soon enough, and distrust of clinicians.Switching to a system based on triage with human papillomavirus testing followed by cytology if indicated may be feasible, Dr. French said, “but we’re not quite there yet, partly because of the expense of the test and we have to know that approach would be reliable.” (See Reuters Health report, December 4, 2003).”In theory,” she added, “women could do their own swab for HPV testing,” a more cost-effective and practical approach.(Source: Ann Fam Med 2003;1:203-208: Reuters Health: Karla Gale: December 5, 2003: Oncolink)