Fear plays a major role in whether women decide to go for cancer screening or not, but healthcare providers underestimate how much women need to know and wrongly assume that they will ask for information if they want it.
Those are the two key findings from a study published in the June issue of the UK-based Journal of Advanced Nursing.
US researchers Dr Kelly Ackerson and Dr Stephanie Preston reviewed 19 studies that between them explored the attitudes of 5,991 women to breast and cervical cancer screening. The studies, which covered the period 1994 to 2008, included women of all ages, from 14 year-old teenagers to women in their eighties.
"Our review showed that fear could motivate women to either seek screening or to avoid screening" says nurse researcher Dr Ackerson, an Assistant Professor at Western Michigan University, USA.
"Some women complied because they feared the disease and saw screening as routine care, but other women feared medical examinations, healthcare providers, tests and procedures and didn't seek screening if their health was good.
"Lack of information was a big barrier. It was clear from our review that very few women understood that cervical smear testing aims to identify abnormal cells before they become malignant and that breast screening can detect cancer in the early stages when treatment is most effective.
"The review also highlighted that many women had misconceptions about breast and cervical cancer and who was at risk. For example, some women felt they did not need breast or cervical screening after a certain age and some believed that they could not develop cervical cancer if they weren't in a current sexual relationship.
"Women who did not have a family history of cancer were also less likely to think they were at risk. Because there has been a lot of publicity about the role that family history can play in breast cancer, many women assumed wrongly that the same family patterns can apply to cervical cancer."
Figures from the USA and UK show that there is a big gap between the number of women invited for screening and the number who actually attend.
In 2007 the Centers for Disease Control and Prevention in America estimated that 25 per cent of women aged 40 plus had not had breast screening in the last two years and 16 per cent aged 18 and over had not had a cervical smear in the last three years.
Cancer Research UK figures for the same year suggest that 4.4 million women were invited for cervical smears but only 3.6 million (82 per cent) attended.
Breast cancer rates are similar in both countries, despite differently funded healthcare systems and screening criteria, but a lower percentage of UK women die from cervical cancer.
The researchers have come up with three key recommendations as a result of their review:
- Nurses should promote screening by educating women of the benefits of breast and cervical screening even when they do not ask for information.
- Initiatives aimed at increasing uptake rates should focus on women's fears about the procedure or a possible positive result.
- Public health messages need to specifically target women who do have access to healthcare but fail to undergo routine testing.
"Nurses have a key role to play in addressing the fears and lack of knowledge that women have when it comes to screening for breast and cervical cancer" concludes Dr Ackerson.
"They need to help women understand both the risks and benefits of screening so that they can make informed choices about whether or not they want to be tested."
Full bibliographic information
A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. Ackerson K and Preston S. Journal of Advanced Nursing. 65.6, 1130-1140. (June 2009).