The mean age at diagnosis of cervical cancer (CC) is 51 yrs old. Recommendations on cervical cancer screening has recently been implemented as a nationally organized program in France. Since 2018, women aged 25-65 yrs are now invited for a every 3 years pap smear test. It therefore appeared important to gain clearer insight into the characteristics of women who have had at least one Pap smear tests but have not returned after the recommended 3-year interval for a repeat test.
The French nationwide observational survey EDIFICE 6 was conducted online from 26 June to 28 July 2017 on 12 046 individuals (age, 18-69 yrs). 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 the non-uptake of subsequent CC screening. The present analysis included 4499 women (25-65 years) with no history of cancer.
Of those who were in the target age range for CC screening, 15% (N = 671) did not return for the repeat examination within the recommended 3 years. Compared to those who were compliant with the recommendations, the population of non-compliant women was older (mean age 49.2 yrs vs 43.2 yrs). It was characterized by higher proportions of women living alone (single, widow or divorced, 40% vs 30%, P < 0.05), socially vulnerable individuals (55% vs 35%, P < 0.05), smokers (35% vs 26%, P < 0.05) and lower proportions of high socioprofessional categories (23% vs 34%, P < 0.05). In multivariate analysis, the items associated with non-compliance included: social vulnerability (OR = 1.78, 95% CI [1.49-2.12]), current smoking (OR = 1.54 [1.28-1.85]) and rating as “not important” the progress enabled by clinical research (OR = 1.49 [1.10-1.99]). The most frequently cited reasons for non-uptake of subsequent pap smear test were "I don’t feel concerned" (48%), “individual negligence/not a priority” (42%), reasons related to the physician (27%) or to the examination/results (22%).
Our findings highlight the need for novel awareness campaigns that specifically target the population which drops out CC screening (including, socially vulnerable women and smokers).
Clinical trial identification
Potentiel d’Action (France), funded by Roche.
Legal entity responsible for the study
T. de La Motte Rouge: Honoraria (self): Roche. F. Eisinger: Honoraria (self): Roche. S. Couraud: Honoraria (self): Roche. L. Greillier: Honoraria (self): Roche. C. Lhomel: Full / Part-time employment: Roche. M. Rouprêt: Honoraria (self): Roche. J. Morere: Honoraria (self): Roche. All other authors have declared no conflicts of interest. Scientific clarification and Linguistic correction