Free pap screening did not increase participation

1,562 women were offered free gynecological pap test screening in three socioeconomically disadvantaged areas in Gothenburg, in 2013. A new study from Sahlgrenska Academy, Närhälsan and the Regional Cancer Center West now shows that these women did not participate to a greater degree than the group that was offered the screening for the usual fee.

Not participating in gynecological pap test screening is the single greatest risk factor in Sweden for acquiring and dying of cervical cancer.

1,562 women in the Gothenburg areas of Angered, Bergsjön and Biskopsgården were offered free pap test screenings in 2013, and their participation has now been compared with the same number of women that were offered the screening for the usual fee of SEK 100

Surprised by the results

The results, which were published in the American journal PLoS One, shows that 37 percent of the randomly assigned free group participated, compared to 39 percent of those who had to pay. This slight difference is not statistically significantly.

"We were actually surprised by the results. We thought that free pap test screening would increase participation, particularly in the socioeconomically disadvantaged areas that have lower participation than the rest of the city," says Emilia Alfonzo, Gynecologist and one of the researchers behind the study.

The fee is low

Researchers also examined if there were any differences among women participating the first time, if they had previously not attended or if a woman's age was a factor; but, none of that proved significant.

"This result should not be used as an argument to raise fees or introduce fees where it has previously been free," emphasizes Björn Strander, Principal Researcher of the study.

"You have to remember that the fee is low, € 11, and a higher fee can very well be a deterrent. But the results teach us that funds that could be used to remove this low fee, could better be used elsewhere. Making it easier for women to get pap test screening is important and there are other measures that have been proven very effective," says Björn Strander.

Other ways to increase participation

Measures that have proven effective in increasing participation are, for example, prebooked appointments that are simple to rebook, annual reminders or telephone contact by a midwife for those who do not show, as well as mailing offers for self-testing to women that have chosen not participate for a long time.

Facts on pap cell screening participation

In Gothenburg's municipality, 47 percent of the women participated within 90 days of having received an appointment (2015). In Västra Götaland Region (VGR), 67 percent participated, while the national average is 55 percent. More women occasionally participate, such as after a reminder, and the coverage of women that has participated in the screening during the recommended interval (three or five years depending on age) is 89 percent in VGR, while the national average is 81 percent.

The article Effect of fee on cervical cancer screening attendance - ScreenFee, a Swedish population-based randomised trial was published in PLoS One March 17.