Improving attendance rates

Cervical cancer can be prevented by early detection and treatment of pre-cancerous lesions before they develop into cancer. This is the goal in cervical cancer screening (mass screening). All women aged 30-60 are invited for a Pap-smear (a cell sample from the cervix) in 5-year intervals.  

Attendance rate in screening among all invited women is approximately 70% but among women aged 30–35 years only 50-60%. A marked proportion of cervical cancers are found in those women who do not take part in screening. Actions have been taken to improve attendance rates and prevent as many cancers as possible. 

Among the youngest age-groups invited to screening, the risk factors of cervical cancer screening are becoming more common. The most important risk factor for the development of cervical cancer is a human papillomavirus (HPV) infection. HPV-infections are common among young people as they start their sex life, but in most cases the body’s immune system clears HPV naturally within two years. In the case of a prolonged HPV-infection, the development of cell abnormalities in the cervix and genital area are possible. HPV-infections and smoking among women have become more and more common during the last few decades. As young women at the same time do not take part in screening, also cervical cancer becomes more common.  

According to recent questionnaire based studies, general reasons for not taking part in screening are: practical difficulties with the screening appointment and place, forgetting the screening appointment or a recent Pap-smear taken elsewhere.  

Taking part in screening is, however, always worthwhile; even in the case of a Pap-smear taken recently for other purposes. Research has shown that organised screening is more effective than Pap-smears taken outside the screening programme in protecting women from cervical cancer. Also pregnancy, breast-feeding or hysterectomy do not prevent form taking part in screening. 

Attendance can be improved by using pre-fixed appointment times, by enabling the change of time by phone or in the internet, and by sending reminder letters to non-participants. A new potential method of increasing the attendance rates are screening tests taken at home.