Cervical screening, compliance and moral obligation

Abstract

Cervical screening has been subject to extensive scrutiny within the social sciences over the last two decades. Moreover, it has been described, in passing, as an example of 'surveillance medicine' through which new aspects of people's lives are brought under medical scrutiny. Cervical screening is an example of secondary prevention with which women, on the whole, are expected and encouraged to comply, in what are deemed to be their best interests. However, the social science literature on cervical screening tends to present compliance as a morally neutral and unproblematic response to information about disease prevention. In contrast, this paper seeks to illustrate how women draw on specific contexts and relationships through which participation in, or compliance with screening, is given meaning. Drawing on women's accounts of their experience of screening participation, the paper suggests that compliance with cervical screening cannot be viewed exclusively as a morally neutral, if desirable, outcome of disease prevention initiatives, but may also be embedded within a moral framework of selfresponsibility and social obligation.

Women's Experiences With Mammography Screening Through 6 Years of Participation—A Longitudinal Qualitative Study

“…Participation in mammography screening programmes is for most women initiated by an invitation informing women about the risk of breast cancer and completed by the reception of the screening outcome. Feeling at risk, screening might provide a degree of ontological security, a "peace of mind", at least symbolically (Willis, 2004;Howson, 1999). When health authorities initiate such programmes, it indicates that all women are involved in what has been described by Petersen (1997) as "the process of eventually becoming ill".…”

“…Receiving an invitation to screening seems to influence women's decisions about participation (Østerlie et al, 2008;Forss et al, 2001). When self-surveillance is not enough, screening allows women to take further responsibility through accepting participation in a screening program when invited (Howson, 1999;Pfeffer, 2004a). Especially within the European context, the framing and timing of screening invitations might be of importance.…”

“…The routine aspect of screening participation may, however, influence how women experience cancer surveillance (Howson, 1999). Reoccurring tests such as mammography might even be a (bi)annual reminder that 6 the body is, or should be, under surveillance (Kaufert, 1996;Kaufert, 2000).…”

“…Reoccurring tests such as mammography might even be a (bi)annual reminder that 6 the body is, or should be, under surveillance (Kaufert, 1996;Kaufert, 2000). Seeing participation as a routine or habit may contribute to give screening an air of a normal and naturalised practice in women's lives, maybe even an obligation (Howson, 1999;Willis, 2004). Such routinization may be understood as how medicalization becomes a feature of daily living: what was a contested medical intervention when it first appeared in lay peoples' lives has been transformed into a normal life event as time goes by (Anderssen, 2010).…”

“…Beck & Beck-Gernsheim suggest the term testponsibility to describe the responsibility of individuals to participate in available health examinations. Women who are invited regularly to mammography screening seem to perceive participation as responsible behaviour (Willis, 2004;Howson, 1999).…”