Uptake Of Cervical Screening Research Articles

Strategies for increasing uptake of cervical screening

Practice nurses can help get cervical screening back on the rise by understanding the reasons for non-attendance and then tailoring the primary care provision to encourage more women to have the test, writes Aine Kothari Cervical screening uptake is declining throughout the UK. A knowledge of the reasons for non-attendance can be used to tailor primary care provision of cervical screening to encourage women to respond to their screening invitation. Cervical screening saves lives by early detection and treatment of pre-cancerous abnormalities. The cervical screening procedure takes approximately 15 minutes and the result is generally available within two weeks of the test. This article discusses the barriers to attendance and the strategies that might be adopted to reverse the downward trend in screening uptake.

Message framing in invitation letters for cervical screening: a randomised controlled trial

BackgroundCervical screening saves 4500 lives in England annually and is offered nationally to women aged 24–64 years. A successful screening programme relies among other factors on uptake by the at-risk population. National coverage fell from 80·3% in 2005 to 77·2% in 2015. How health information is framed, in terms of potential gains (eg, lives saved) versus losses (eg, lives lost) of taking part in screening, can affect uptake. This study aimed to investigate the effect of framing in invitation letters for cervical screening on attendance in a low uptake urban area of London. MethodsIn a randomised controlled trial, two simplified invitation letters were compared with the existing invitation letter (control). Women living in the trial area, who were due for screening between Oct 21 and Dec 16, 2015, were randomised to receiving a gain framed message, a loss framed message, or the existing invitation letter (1:1:1, by computer-generated random number). Participants but not investigators were masked to allocation. Primary outcome was attendance for cervical screening at 15 and 32 weeks. Association between framing and attendance was measured with logistic regression. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN93653543. Findings6223, 6223, and 6202 women were allocated to the control, gain framed, and loss framed groups, respectively. Mean age was 35·4 years (SD 9·9). Median number of invitations previously received was 4 (IQR 2–6) and past attendances was 1 (0–4). At 15 weeks no significant difference in uptake between the groups was found. Attendance at 32 weeks was 32·7% (n=2032) in the control compared with 32·3% (2011) in the gain framed group and 33·5% (2079) in the loss framed group. Logistic regression showed a significant increase in uptake in the loss framed group (adjusted odds ratio 1·1, 95% CI 1·0–1·21; p=0·04). No adverse events were observed. InterpretationOverall, the use of loss framing in invitation letters for cervical screening can increase the uptake of cervical screening at little or no extra cost. This study highlights one example of how information in invitation letters can be made more salient. Further research to explore these techniques is required. How changes in content might affect uptake is difficult to predict, so further trials in diverse populations are needed to ensure that new interventions are effective and not detrimental to uptake. FundingDepartment of Health.

Understanding barriers to cervical screening uptake in trans men: an exploratory qualitative analysis

BackgroundCervical cancer is one of the most frequently encountered gynaecological malignancies that is highly preventable through screening. Therefore, screening for cervical cancer is a public health priority. No recommendations exist for screening lesbian or bisexual women or for female to male transgender individuals. Evidence suggests that trans men attend cervical screening far less than cisgendered women and also are more likely to receive an inadequate cervical smear test. We aimed to explore barriers to cervical screening uptake in trans men. MethodsQualitative interviews were carried out with trans men who had an intact cervix and were eligible for cervical screening. Recruited through trans organisations, seven participants based in London and Manchester were interviewed or took part in a focus group. Because of the sensitive nature of the research, there were few expressions of interest for the study, so every request was highly valued. Interview and group discussions were audio-recorded, transcribed verbatim, and analysed by thematic analysis. Ethics approval was granted from London Metropolitan University. FindingsFour themes emerged. The trans men reported the importance of social and peer support in providing motivation to seek health care. The need for their gender identity, post-transition, to be accepted by health-care professionals was crucial in influencing the decision for screening uptake. Despite the participants' understanding of the importance of cervical screening on their health, previous negative experiences deterred attendance. There was a recognition that education about the importance of screening within the trans community was needed. InterpretationTrans men need sensitive and respectful cervical screening experiences. Promotion of cervical screening through provision of education for trans men and health-care professionals is essential to increase awareness and understanding of the importance of screening in this group and to develop sensitive environments for screening to take place. Although we interviewed a small sample, our findings are novel and valuable. Future research is needed to develop interventions to increase understanding and awareness, promote screening attendance, and create a trans friendly environment. Guidelines for delivering appropriate services are warranted. FundingNone.

A survey of cervical screening among refugee and non-refugee African immigrant women in Brisbane, Australia.

Issue addressed To compare the level of cervical screening uptake between refugee and non-refugee African immigrant women living in Brisbane, Australia, and examine factors associated with Pap smear testing. Methods Cross-sectional survey with a convenience sample of 254 women aged 21-62 years from 22 African countries (144 refugees, 110 non-refugees). Chi-square tests were used to compare the demographic and health-related characteristics between refugee and non-refugee women. Bivariate and multiple logistic regression analyses were used to assess the relationship between the outcome variable (Pap smear testing) and the independent variables. Results Two-thirds of women had used Pap smear services in Australia. Chi-square test analysis established that non-refugee women were significantly more likely to have used Pap smear services than refugee women (73.6% vs 61.8% respectively; P=0.047). Immigration status, however, was not a significant predictor of cervical screening uptake in the multiple regression analyses. The significant predictors for screening uptake in these analyses were work arrangement, parity, healthcare visit, knowledge about Pap smear and perceived susceptibility to cervical cancer. Conclusion Most women relied on opportunistic screening after receiving invitation letters to screen or after visiting health professionals for antenatal or postnatal care. So what? The findings suggest that organised cervical screening programs are not reaching most African immigrant women living in Brisbane. It is incumbent on the public health sector, including healthcare professionals and settlement agencies working with African communities, to develop health promotion strategies that meaningfully engage African immigrant women, including those from refugee backgrounds, to enhance their knowledge about cervical cancer and screening practices.

Strategies to increase cervical screening uptake

There has been an increase in the incidence of cervical cancer in women under 35, and a decrease in young women taking up cervical screening invitations.

Cervical and breast cancer screening uptake among women with serious mental illness: a data linkage study.

BackgroundBreast and cancer screening uptake has been found to be lower among women with serious mental illness (SMI). This study aims to corroborate these findings in the UK and to identify variation in screening uptake by illness/treatment factors, and primary care consultation frequency.MethodsLinked population-based primary and secondary care data from the London borough of Lambeth (UK) were used to compare breast and cervical screening receipt among linked eligible SMI patients (n = 625 and n = 1393), to those without SMI known only to primary care (n = 106,554 and n = 25,385) using logistic regression models adjusted first for socio-demographic factors and second, additionally for primary care consultation frequency.ResultsEligible SMI patients were less likely to have received breast (adjusted odds ratio (OR) 0.69, 95 % confidence interval (CI), 0.57 - 0.84, p < 0.001) or cervical screening (adjusted OR 0.72, CI: 0.60 - 0.85, p < 0.001). Schizophrenia diagnosis, depot injectable antipsychotic prescription, and illness severity and risk were associated with the lowest odds of uptake of breast (adjusted ORs 0.46 to 0.59, all p < 0.001) and cervical screening (adjusted ORs 0.48 - 0.65, all p < 0.001). Adjustments for consultation frequency further reduced effect sizes for all subgroups of SMI patient, in particular for cervical screening.ConclusionsWomen with SMI are less likely to receive breast and cervical cancer screening than comparable women without SMI. Higher primary care consultation rates among SMI patients is likely a mediating factor between SMI status and uptake, particularly for cervical screening - a service organised in primary care. To tackle health disparities linked to SMI, efforts at increasing screening uptake are key and should be targeted at women with other markers of illness severity or risk, beyond SMI status alone.

A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC).

Falling participation by young women in cervical screening has been observed at a time that has seen an increase in the incidence of cervical cancer in the UK in women aged < 35 years. Various barriers to screening have been documented, including fear, embarrassment and inconvenience. To measure the feasibility, clinical effectiveness and cost-effectiveness of a range of interventions to increase the uptake of cervical screening among young women. A cluster randomised trial based on general practices performed in two phases. Primary care in Greater Manchester and the Grampian region in Scotland. Phase 1: 20,879 women receiving their first invitation for cervical screening. Phase 2: 10,126 women who had not attended by 6 months. Phase 1: pre-invitation leaflet or not, and access to online booking (Manchester only). Phase 2: (1) vaginal self-sampling kits (SSKs) sent unrequested (n = 1141); or (2) offered on request (n = 1290); (3) provided with a timed appointment (n = 1629); (4) offered access to a nurse navigator (NN) (n = 1007); or (5) offered a choice between a NN or a SSK (n = 1277); and 3782 women in control practices. Uplift in screening compared with control practices, cost-effectiveness of interventions, and the women's preferences explored in a discrete choice experiment. The pre-invitation leaflet and offer of online booking were ineffective when compared with control practices at 3 months, 18.8% versus 19.2% [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.88 to 1.06; p = 0.485] and 17.8% versus 17.2% (OR 1.02, 95% CI 0.87 to 1.20; p = 0.802), respectively. The uptake of screening at 3 months was higher among previously human papillomavirus (HPV)-vaccinated women than unvaccinated women, 23.7% versus 11% (OR 2.07, 95% CI 1.69 to 2.53; p < 0.001). Among non-attenders, the SSK sent intervention showed a statistically significant increase in uptake at 12 months post invitation, 21.3% versus 16.2% (OR 1.51, 95% CI 1.20 to 1.91; p = 0.001), as did timed appointments, 19.8% versus 16.2% (OR 1.41, 95% CI 1.14 to 1.74; p = 0.001). The offer of a NN, a SSK on request, and a choice between timed appointments and NN were ineffective. Overall, there was a gradual rather than prompt response, as demonstrated by uptake among control practices. A discrete choice experiment indicated that women invited who had not yet attended valued the attributes inherent in self-sampling. The health economic analysis showed that both timed appointments and unsolicited SSK sent were likely to be cost-effective at a cost per quality-adjusted life-year (QALY) gained of £7593 and £8434, respectively, if extended across the national 25-year-old cohort throughout the duration of screening. The certainty of these being cost-effective at a ceiling ratio of £20,000 per QALY gained was > 90%. Women receiving their initial screening invitation frequently delay taking up the offer and the net impact of interventions was small. Timed appointments and SSKs sent to non-attenders at 6 months are likely to be a cost-effective means of increasing uptake and should be considered further. HPV vaccination in the catch-up programme was associated with an increased uptake of cervical screening. Future work should focus on optimising self-sampling in terms of age range, timing of offer for non-attenders and use of urine testing instead of vaginal samples. Current Controlled Trials ISRCTN52303479. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 68. See the NIHR Journals Library website for further project information.

HPV testing: a mixed-method approach to understand why women prefer self-collection in a middle-income country.

BackgroundHPV test self-collection has been shown to reduce barriers to cervical screening and increase uptake. However, little is known about women’s preferences when given the choice between self-collected and clinician-collected tests. This paper aims to describe experiences with HPV self-collection among women in Jujuy, the first Argentinean province to have introduced HPV testing as the primary screening method, provided free of cost in all public health centers.MethodsBetween July and December 2012, data on acceptability of HPV self-collection and several social variables including past screening were collected from 2616 self-collection accepters and 433 non-accepters, and were analyzed using multivariate regression. In addition, in-depth interviews (n = 30) and 2 focus groups were carried out and analyzed using thematic analysis.ResultsQuantitative findings indicate that main reasons for choosing self-collection are those reducing barriers related to women’s roles of responsibility for domestic work and work/family organization, and to health care services’ organization. No social variables were significantly associated with acceptability. Among those who preferred clinician-collection, the main reasons were trust in health professionals and fear of hurting themselves. Qualitative findings also showed that self-collection allows women to overcome barriers related to the health system (i.e. long wait times), without sacrificing time devoted to work/domestic responsibilities.ConclusionsFindings have implications for self-collection recommendations, as they show it is the preferred method when women are given the choice, even if they are not screening non-attenders. Findings also highlight the importance of incorporating women’s needs/preferences in HPV screening recommendations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3474-2) contains supplementary material, which is available to authorized users.

Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis.

ObjectiveAs uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call–recall programme, in order to understand the barriers to informed uptake.MethodsWe searched nine databases for English language peer‐reviewed publications reporting on qualitative data from screening‐eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call–recall programme. Evidence was integrated using thematic synthesis.ResultsThirty‐nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action.ConclusionsThe variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review.

Cervical cancer is the commonest cause of cancer-related death in Sub Sahara Africa (SSA). Both primary and secondary preventive services are available but utilisation remain low. This systematic review aims to summarise reported barriers preventing women from utilising cervical cancer screening services in SSA. Electronic searches on MEDLINE, EMBASE, PsycINFO, BIOSIS preview, Global Health, PubMed, Cochrane library, CINAHL, ISI Web of Knowledge and Google scholar and quality assessment of the included studies were performed. A meta-analysis was applied to identify major themes. Eight studies exploring reasons women did not utilise cervical cancer screening were included. Women in SSA reported similar barriers despite cultural and language diversity in the region. Women reported fear of screening procedure and negative outcome, low level of awareness of services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatisation, cost of accessing services and health service factors like proximity to facility, facility navigation, waiting time and health care personnel attitude. Strategies for improving uptake and utilisation of cervical screening in SSA should focus on improving cervical health education, addressing cultural beliefs and practices and improving spousal support and empowering women, as well as addressing physical access problem, costs and improving staff attitude.

HPV immunisation and increased uptake of cervical screening in Scottish women; observational study of routinely collected national data.

Background:To measure the uptake of first invitation to cervical screening by vaccine status in a population-based cohort offered HPV immunisation in a national catch-up campaign.Methods:A retrospective observational study of routinely collected data from the Scottish Cervical Screening Programme. Data were extracted and linked from the Scottish Cervical Call Recall System, the Scottish Population Register and the Scottish Index of Multiple Deprivation. Records from 201 023 women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. Attendance for screening was within 12 months of the first invitation at age 20 years.Results:There was a significant decline in overall attendance from the 1988 cohort to the 1993 cohort with the adjusted attendance ratio of the 1988 cohort being 1.49 times (95% CI 1.46–1.52) that of the 1993 cohort. Immunisation compensated for this decrease in uptake with unvaccinated individuals having a reduced ratio of attendance compared with those fully vaccinated (RR=0.65, 95% CI 0.64–0.65). Not taking up the opportunity for HPV immunisation was associated with an attendance for screening below the trend line for all women before the availability of HPV immunisation.Conclusions:HPV immunisation is not associated with the reduced attendance for screening that had been feared. Immunised women in the catch-up cohorts appear to be more motivated to attend than unimmunised women, but this may be a result of a greater awareness of health issues. These results, while reassuring, may not be reproduced in routinely immunised women. Continued monitoring of attendance for the first smear and subsequent routine smears is needed.

Socio-Demographic Characteristics Influencing Uptake of Screening for Cervical Cancer in Women Aged 18-49 Years in Imenti North Sub-county, Meru County, Kenya

Background: Cervical cancer continues to kill approximately 274,883 women globally every year, despite robust programs for the prevention and control of the disease. Kenya has an uptake of cervical cancer screening (3.2%) compared to the National Cervical Cancer Prevention program target of 70%. The purpose of this study was to determine the socio-demographic characteristics influencing uptake of cervical cancer screening in Imenti North Sub-County. Methods: This was institution-based descriptive cross- sectional study conducted among 422 randomly selected women aged 18-49 years attending general outpatient clinics in health facilities of Imenti North Sub-County, Kenya. Health Facilities were stratified based on functional levels to include county referral, health centers and dispensaries. Data was collected using interviewer administered questionnaire Characteristics influencing uptake of cervical cancer screening were analyzed using chi-square test and logistic regression to determine predictors for cervical cancer screening. Results: The study found out that the level of uptake for cervical cancer screening by the respondents was 15.2%. However, the level of the uptake was lowest among women aged 18-25 (4.4%) and women with primary level of education (11.6%). In addition, the study found significant association between uptake and age (p-value . Other significant socio-demographic characteristics include marital status and level of education. Women in age category 42-49 years were 6 times more likely to be screened compared to women aged 18-25 years (p-value=0.022). Conclusion and recommendations: The level of uptake for cervical cancer screening by the respondents was 15.2%. The main determinants of uptake of screening were age, marital status, occupation, and high level of education. It was recommended that Health Managers should conduct refresher seminars for health workers, increase facilities offering screening services and intensify community health education in order to increase uptake of cervical cancer screening.

Breast and cervical cancer screening in Great Britain: Dynamic interrelated processes.

No previous analysis has investigated the determinants of screening uptake for breast and cervical cancer screening for possible spillover effects from one type of screening examination to the other type of screening examination with a dynamic bivariate panel probit model. For our analysis, we used a dynamic random effects bivariate panel probit model with initial conditions (Wooldridge-type estimator) and dependent variables were the participation of breast and cervical cancer screening in the recent year. The balanced panel sample consisted of 844 women from the British Household Panel Survey (BHPS) from the time period 1992 to 2008. Our analysis showed the high relevance of past screening behaviour and the importance of state dependency for the same and the other type of cancer screening examinations even after controlling for covariates and unobserved heterogeneity. The uptake for breast and cervical cancer screening was higher when the same screening examination was done one or three years earlier. This result is in accordance with the medical screening programmes in Great Britain. With regard to breast and cervical cancer screening positive spillover effects existed between screening examinations in the third order lags. Women with a previous visit to a general practitioner and individuals in the recommended age groups had a higher uptake for breast and cervical cancer screening. Other socioeconomic and health related variables had non-uniform results in both screening examinations. Promoting the uptake of one female prevention activity could also enhance the uptake of the other prevention activity.

Motivations and barriers to cervical cancer screening among HIV infected women in HIV care: a qualitative study.

BackgroundCervical cancer is the second commonest cancer in women worldwide and the commonest cancer among women in Uganda. Annual cervical screening is recommended for women living with HIV for early detection of abnormal cervical changes, however uptake remains grossly limited. This study assessed factors associated with cervical screening uptake among HIV infected women at Mildmay Uganda where cervical screening using Visual inspection with acetic acid and iodine (VIA and VILI) was integrated into HIV care since July 2009.MethodsEighteen (18) in-depth interviews with HIV infected women and 6 key informant interviews with health care providers were conducted in April 2013 to assess client, health care provider and facility-related factors that affect cervical screening uptake. In-depth interview respondents included six HIV infected women in each of the following categories; women who had never screened, those who had screened once and missed follow-up annual screening, and those who had fully adhered to the annual screening schedule. Data was analyzed using content analysis method.ResultsMotivations for cervical cancer screening included the need for comprehensive assessment, diagnosis, and management of all ailments to ensure good health, fear of consequences of cervical cancer, suspicion of being at risk and the desire to maintain a good relationship with health care workers. The following factors negatively impacted on uptake of cervical screening: Myths and misconceptions such as the belief that a woman’s ovaries and uterus could be removed during screening, fear of pain associated with cervical screening, fear of undressing and the need for women to preserve their privacy, low perceived cervical cancer risk, shortage of health workers to routinely provide cervical cancer education and screening, and competing priorities for both provider and patient time. Major barriers to repeat screening included limited knowledge and appreciation of the need for repeat screening, and lack of reminders.ConclusionsThese findings highlight the need for client-centered counseling and support to overcome fears and misconceptions, and to innovatively address the human resource barriers to uptake of cervical cancer screening among HIV infected women.

P14.02 Systematic review: does a positive human papillomavirus vaccination status increase the risk of unsafe sexual health practice in australian women?

Background The human papillomavirus (HPV) is a sexually transmitted infection responsible for the majority of cervical and anogenital cancers. HPV vaccination aims to reduce this risk especially against the four most influential strains, HPV genotype 6, 11, 16 and 18. However, it is not known if HPV vaccination also exerts an influence over sexual behaviour. The objective of this study is to investigate whether a positive HPV vaccination increases the risk of engaging in unsafe sexual health practice. Methods A systematic literature search was conducted in MEDLINE, Scopus, Embase, Discovery and Google Scholar, from the 1 st of January 2007 to the 1 st of March 2015. Titles, abstracts and in case of relevance, full-texts, were screened according to predefined inclusion and exclusion criteria. Relevant study characteristics and results were transcribed and narratively synthesised into a pre-specified form. Each study was critically appraised by three researchers in accordance with internationally accepted criteria (STROBE, CONSORT, PRISMA). Results Four relevant studies were identified and each assessed differing aspects of HPV vaccination and its association with sexual health. Vaccination was not a significant predictor of perceived vulnerability to cervical cancer (p = 0.601), intention to participate in HPV screening (p = 0.521) or uptake of cervical screening (p = 0.181). HPV vaccination was not a significant predictor of safer sexual behaviour (p = 0.515) or consistent condom use (p = 0.876). Conclusion The results have proven inconclusive, as there is insufficient evidence to support or refute that HPV vaccination increases the risk of unsafe sexual behaviours. Notwithstanding, we observed a number of misconceptions regarding HPV, vaccination programs and cervical cancer screening. A positive HPV vaccination status contributed to a sense of complacency regarding the need for regular cervical cancer screening. Moreover, unvaccinated women were more likely to believe that HPV vaccine could be used as treatment for cervical cancer. As such these issues must be addressed in future research. Disclosure of interest statement Nothing to declare

Effect of Human Papillomavirus vaccination of daughters on the cervical screening uptake of their non-vaccinated mothers.

This study investigated return to cervical screening rates for 112,451 under-screened mothers of daughters offered Human Papillomavirus (HPV) vaccination over two school academic years and a comparator group of women with no vaccine-eligible daughter. Mothers returned to screening more often than the comparator group: odds ratio (OR) 1.04 (95% confidence intervals 1.02-1.07) for lapsed and 1.57 (1.48-1.67) for never screened. Screening return was significantly higher in the year prior to HPV vaccination for lapsed mothers (OR = 1.06) and in the current vaccination year for lapsed and never screened mothers (OR = 1.05 and 1.16 respectively). The modest increase in screening attendance indicates a potential for the HPV vaccine programme to increase screening uptake of mothers.

Public health promotion: the role of the dermatologist

The uptake of cervical screening has been falling year on year within the U.K. population for the last 10 years.1 The year 2009 was an exception to this, thought to be a response to the widespread media coverage of Jade Goody's diagnosis of cervical cancer. Since then the downward trend has resumed. This is particularly notable in young women aged 25–49 years.2 In this month's issue of the BJD, Clowry et al.3 show the beneficial effect that dermatologists can have on uptake of cervical screening among their patients. In a sample of 104 patients, 85% had been screened at least once and 87% within the last 3 years. As they note, this compares very favourably with the national programme uptake of 70%.1 Although we cannot conclude that it was the advice from dermatologists that resulted in high uptake, it appears that their advice had a greater impact on patients: 59% of participants said they remembered dermatologists talking to them about the importance of cervical screening, compared with only 15% remembering advice from general practitioners (GPs). Women may be more likely to remember the advice from dermatologists when asked about it in a dermatology clinic; however, we should take advantage of any potential intervention that can increase screening uptake.

PWE-052 Low uptake of cervical screening in immunosuppressed patients with inflammatory bowel disease at a district general hospital

Introduction ECCO guidelines strongly recommend regular cervical screening for women with inflammatory bowel disease (IBD), especially if treated with immunomodulators. We wanted to investigate if our immunosuppressed female IBD patients were being screened in accordance with the NHS Cervical Screening Programme (CSP) and identify if they were at increased risk of cytological abnormalities. Method We searched our database for patients commenced on azathioprine, mercaptopurine, methotrexate, infliximab or adalimumab from June 2005 to October 2013. We excluded patients who were on these drugs for less than one year, were not of cervical screening age (25–64) or had had a hysterectomy. Information provided from general practitioners, local cytology department and Open Exeter (CSP database) were used to identify women participating in CSP and if they showed any abnormalities. Results 153 patients met the criteria to participate in the CSP. 115 (75%) were up-to-date compared to a national participation rate of 78.3%. 25 (16%) had participated in the CSP but were not up-to-date at the time of report. 9 (6%) had not participated in the CSP and 4 (3%) actively declined participation. Date from the 2013 National CSP demonstrates that 5.3% of those screened displayed low grade abnormalities and 1.2% had high grade abnormalities. Of our 153 patients 13 (8.5%) had cytological abnormalities. 5 (3%) patients had abnormalities before immunosuppressive therapy with 1 (0.7%) patient showing high grade abnormality (moderate dyskaryosis with CIN1 confirmed) which subsequently remained negative whilst on immunosuppression. Our results identified 7 (4.6%) patients with low grade abnormal cytology results after commencing immunomodulators (3; borderline nuclear changes in squamous cells, 2; mild dyskaryosis, 2; low grade dyskaryosis and high risk HPV detected). Only 1 (0.7%) patient had high grade dyskaryosis during immunosuppression but their follow up cytology was negative. Conclusion IBD patients are at increased risk of cytology abnormalities which is concerning since our CSP participation is below the national average. However data from our unit suggests that commencing immunosuppression therapy did not increase that risk any further. This data underlines that IBD specialists need to educate and encourage patients to participate in the CSP programme. Disclosure of interest K. Wade Conflict with: Abbvie sponsorship to attend ECCO, H. Johnson: None Declared, H. Dewhurst: None Declared, S. Weaver Conflict with: been on advisory board for MSD and Abbvie but not for past 12 months, S. McLaughlin Conflict with: Abbvie sponsorship to attend DDW, Abbvie Advisory board, Ferring sponsorship to attend ECCO.

High-Risk Human Papillomavirus (HPV) Infection and Cervical Cancer Prevention in Britain: Evidence of Differential Uptake of Interventions from a Probability Survey.

The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) provides an opportunity to explore high-risk human papillomavirus (HR-HPV) and uptake of cervical screening and HPV vaccination in the general population. Natsal-3, a probability sample survey of men and women ages 16 to 74, resident in Britain, interviewed 8,869 women in 2010 to 2012. We explored risk factors for HR-HPV (in urine from 2,569 sexually experienced women ages 16 to 44), nonattendance for cervical screening in the past 5 years, and noncompletion of HPV catch-up vaccination. HR-HPV was associated with increasing numbers of lifetime partners, younger age, increasing area-level deprivation, and smoking. Screening nonattendance was associated with younger and older age, increasing area-level deprivation (age-adjusted OR 1.91, 95% confidence interval, 1.48-2.47 for living in most vs. least deprived two quintiles), Asian/Asian British ethnicity (1.96, 1.32-2.90), smoking (1.97, 1.57-2.47), and reporting no partner in the past 5 years (2.45, 1.67-3.61 vs. 1 partner) but not with HR-HPV (1.35, 0.79-2.31). Lower uptake of HPV catch-up vaccination was associated with increasing area-level deprivation, non-white ethnicity, smoking, and increasing lifetime partners. Socioeconomic markers and smoking were associated with HR-HPV positivity, nonattendance for cervical screening, and noncompletion of catch-up HPV vaccination. The cervical screening program needs to engage those missing HPV catch-up vaccination to avoid a potential widening of cervical cancer disparities in these cohorts. As some screening nonattenders are at low risk for HR-HPV, tailored approaches may be appropriate to increase screening among higher-risk women.

Uptake of Cervical Screening in a Sample of Uk Female Psychiatric Inpatients

Introduction There is little information on cervical screening attendance in the psychiatric population. 78.3% of the general population have been screened once in five years. Evidence suggests that women with mental illness are less likely to engage in recommended health screening programmes. Reasons for non-attendance include shame and embarrassment, lack of knowledge, fear of a positive result, beliefs that the procedure may cause cancer and a high rate of sexual abuse, rendering the procedure too traumatic. Standard Cervical screening in the UK- recommended every 3 years for women aged 25-49 and every 5 years for women aged 50-64. Expected standard 100% Method Cross-sectional survey of psychiatric inpatient sample, including ages 25-64, inpatient sample size 28. Questioned individuals about awareness of cervical screening programme, last/next screening date and cross-correlated with primary care records Results 25 (90%) were aware of cervical screening programme. 20 (70%) claimed correspondence from their doctor and had accepted the screening. Further analysis of primary care records indicated only 8(36%) had actually had the screening, with 20 (64%) being non responders. Conclusion Women with mental illness are 50% less likely to attend a cervical screening programme, compared to general population. Level of education appears to be an important indicator of uptake, regardless of severity and duration of illness. Recommendations Further exploration of identifying barriers to accepting such important screening tests needs to be conducted in the psychiatric population and raising awareness of such screening should not only be the domain of primary care, but also mental health services.