Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study

Abstract

Background A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study. Methods Data from the MARZY prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance. Results At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having ≥ 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening. Conclusions Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness.

Factors Affecting Non-Histologically Proven Invasive Cancer of the Uterine Cervix that Had an Abnormal Pap Smear: Results of the CCS Program

“…In the study, to determine colposcopy nonattendance studied, the potential factors associated with and described non-attendance reasons in a populationbased screening study. Age was not significantly associated with colposcopy attendance among all women referred (Liang et al, 2022).…”

Retrospective survey of colposcopy experience for wāhine Māori across two time periods (2016 and 2021) in Waitematā and Auckland districts, New Zealand

“…Providing efficient information is essential for women to prepare for their appointment, and it may help reduce "Did Not Attend" (DNA) rates. 14,15 The colposcopy service standards in New Zealand 16 advise that women should be given information on available Māori support services. However, only few women were aware of these services in 2021.…”

Real-world effectiveness of cytology and HPV-based screening strategy in cervical cancer screening: A cross-sectional population-based study in Chengdu, China

“…In addition, the age-standardized rates of colposcopy and histopathology attendance in the HPV-based screening strategy were higher than those for cytology, which may be related to the fact that HR-HPV-positive results caused more anxiety or fear of having cervical cancer among screeners, leading to increased referral rates [31]. A study of willingness to colposcopy referral also revealed that a positive HR-HPV result significantly increased attendance by three times [32]. There were some deficiencies of cervical cancer screening program in Chengdu.…”