Fear plays major role in cancer screening decisions among women

MedWire News: Fear plays a major role in cancer screening decisions made by women, but many women have misconceptions about screening and their risk of breast and cervical cancer and would benefit from more information, results of a review show.

In the USA and the UK, figures show that there is a big gap between the number of women invited for screening and the number who actually attend. Indeed, in the USA in 2007, the Centers for Disease Control and Prevention estimated that 25% of women aged 40 years and older had not attended breast screening in the previous 2 years, and 16% of those aged 18 years and older had not had a cervical smear in the past 3 years.

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.

To investigate why some women with access to care do not seek cancer screening, Dr Kelly Ackerson (Western Michigan University, Kalamazoo, USA)  and Dr Stephanie Preston (University of Michigan, Ann Arbor), reviewed the results of 19 studies conducted in the USA, the UK and other countries that explored the attitudes of nearly 6000 women to breast and cervical cancer screening. The studies, which covered the period 1994 to 2008, included women of all ages.

The researchers found that fear was a major factor in women’s screening decisions – it could motivate women to either seek screening or to avoid screening. For example, some women attended screening because they feared breast or cervical cancer and saw screening as routine care, while other women feared medical examinations, healthcare providers, tests and procedures and did not seek screening if they had good health.

The review, published in the Journal of Advanced Nursing, also revealed misconceptions about breast and cervical cancer and who was at risk. Indeed, some women believed that they did not need breast or cervical screening after a certain age and some believed that they could not develop cervical cancer if they were not in a current sexual relationship.

"Lack of information was a big barrier,” said Dr Ackerson. “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.”

Furthermore, 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 risk.

As a result of their findings, the researchers make a number of recommendations. They suggest that nurses should promote screening by educating women about the benefits of breast and cervical screening, even when they do not ask for information.

Furthermore, they say that initiatives aimed at increasing screening uptake rates should focus on women's fears about the procedure or a possible positive result, and that 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."