Cervical cancer (CC) screening is a long-standing practice in France. Since the 1980s, individual screening has led to a substantial reduction in the frequency of these tumors and the associated mortality. However the process is not optimal and an organized program is about to be implemented at a national level in France. In this context, it is important to have a clear insight into the characteristics of women who are resistant to CC screening.
The French nationwide observational survey, EDIFICE 6, was conducted online from 26 June-28 to July 2017 on a core sample of 12 046 individuals (age, 18-69 years). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to explain non-uptake of CC screening. The present analysis included 4499 women (age, 25-65 years) with no history of cancer.
Of those who had never taken part in a screening program, 12% (N = 539) were in the target population for CC screening. Compared to women who had at least one screening test in their life time, the population of never-screened women was characterized by a lower mean age (38±11 yrs vs 44±12 yrs, P<0.05) and higher proportions of single women (48% vs 20%, P<0.05), socially vulnerable individuals (59% vs 38%, P<0.05), and never-smokers (69% vs 49%, P<0.05). In multivariate analysis, items significantly (P<0.05) associated with not undergoing CC screening included living alone (OR=2.26, 95% CI [1.85-2.75]), social vulnerability (OR=1.95 [1.59-2.40]), belonging to the socio-professional categories of unskilled workers (OR=1.89 [1.17-2.94]), skilled manual workers and supervisory or clerical workers (OR=1.80 [1.02-3.05]), and higher managerial and professional occupations (OR=1.74 [1.32-2.28]). The most frequently cited reasons for not undergoing screening were "I don't feel concerned" (40%) and “individual negligence/not a priority” (31%).
Economically active women but also socially vulnerable women, particularly those who are younger, are reluctant to undergo CC screening. These findings are important, notably for vulnerable women who are more at risk of CC.
Clinical trial identification
Medical writing assistance was provided by Potentiel d’Action (France)