Young Danish HPV vaccinated women’s knowledge, barriers and facilitators towards cervical cancer screening: A qualitative study

Abstract

Cervical cancer occurs more often in under-screened women, and participation rates in cervical cancer screening among young women are worryingly low worldwide. In Denmark only about half the women in their twenties participate in cervical cancer screening. 64–80% of women between 20 and 29 have been HPV vaccinated with a vaccine protecting against 70% of all cervical cancers. Thus screening is still an important supplement to HPV vaccination for the next decades. The aim of this study was to investigate knowledge, facilitators and barriers towards cervical cancer screening among young HPV vaccinated women in Denmark. This qualitative study used an anthropological approach, and data was collected using semi structured focus group interviews as this is an effective method for promoting self-disclosure among participants. Eight focus groups were conducted with participation of 49 HPV vaccinated women aged 20–29 years. We identified five main themes providing an understanding of the women’s barriers and facilitators towards cervical cancer screening: Lack of knowledge about HPV and cervical cancer, the screening invitation, the GP as gatekeeper, the gynaecological examination and perceived relevance of cervical cancer screening. Former vaccination did not impact the women’s reflection about screening attendance. We argue that systematic information and the attitude and tone of the GP are the primary facilitators for filling the knowledge gap we found among young HPV vaccinated women. As an important gatekeeper, the GP can explain, motivate and remind young women about the importance of a regular Pap smear.

Women's experiences with opting out of cervical cancer screening and the role of the nurse in the women's decision‐making process

“…One of the main explanations for opting out was the inconvenience of booking an appointment for CCS with a general practitioner, even though the women described having other consultations with their general practitioner. Similarly, other studies also found that practical barriers are described as the cause for opting out of CCS (Chorley et al, 2017;Mortensen et al, 2021). These findings are supported by a previous study which concludes that women who are not participating but have intentions to do so experience more practical barriers to booking an appointment for CCS compared to women who participate regularly (Ryan et al, 2019).…”

“…Women in both this and previous studies described the procedure as uncomfortable, painful, and transgressive, making them opt-out or postpone their participation (Chorley et al, 2017;Mortensen et al, 2021). Yet, one study concluded that a negative attitude toward the gynaecological examination could be overcome if the purpose was relevant to the women's health (Mortensen et al, 2021). This may indicate that the explanations for opting out are only valid to women who do not see themselves as being at risk of getting cervical cancer.…”

“…Women express a need to receive more information about CCS from healthcare professionals, preferably from someone at their general practitioner's office (Borrull-Guardeño et al, 2021;Mortensen et al, 2021). Nurses in general practices can play an active role in informing women to make informed decisions about participation in healthcare services (King & Busolo, 2022;McIlfatrick et al, 2014).…”

The Consensus Project: Participation in cervical cancer screening by the first cohorts of girls offered HPV vaccination at age 15–16 years in Italy

“…In evaluating these data, it should be considered that screening participation is related only to one screening session at age 25 years and only within organised screening. It is well known that young women have lower screening participation rates [30][31][32] and that participation increases with age. In Italy, a large part of test coverage does not take place through organised programmes (Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) 14 surveillance system participation 25-34 years: 39.5% in organised screening and 30.9% in spontaneous screening).…”

Concurrent chemoradiotherapy followed by adjuvant chemotherapy versus concurrent chemoradiotherapy alone in locally advanced cervical cancer: A systematic review and meta-analysis

“…As the most common gynecologic malignant neoplasm reported in women worldwide, the treatment of cervical cancer remains a challenge due to the lack of health infrastructure. In 2018, there were about 36,000 new cases, with 311,365 cancer-related deaths ( 1 ). In many developing countries, patients were diagnosed with cervical cancer at at a locally advanced stage, indicating a poor outcome ( 2 ).…”