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Barriers for Young Women to Participate in The Danish Cervical Screening Program

Background: In Denmark, the coverage rate for cervical cancer screening is about 75% for women aged 23 to 64 years whereas the participation rate is 65%. The participation rate varies with age, and is between 47%-57% among women in their twenties. In 2005, a qualitative study among women between 23 and 39 years found a range of barriers for nonparticipation. Barriers were lack of knowledge about the aim of cervical screening (i.e., the possibilities for early detection and treatment of cervical dysplasia), lack of knowledge about HPV as a very common virus causing dysplasia and cervical cancer and finding the time to make an appointment with the GP. 10 years later a follow-up study among women aged 30 to 50 years found similar barriers (i.e., lack of knowledge about HPV and cervical screening as a preventative method). Despite the different barriers, most women wanted to take part in screening, but a busy everyday life meant that they forgot about the invitation or they did not book an appointment with their GP. Aim: We investigated barriers for participation in the first generation of HPV-vaccinated women in Denmark aged 23 to 29 years. Methods: Qualitative interviews (focus groups) with women aged 23 to 29 years, who had all received one or more invitations to partake in cervical cancer screening, but who had not participated. Results: A preliminary analysis of the first six focus groups identified a handful of interrelated barriers similar to older women. The most important barrier being insufficient knowledge or lack of knowledge about HPV as the cause of dysplasia/cervical cancer (i.e., the high incidence of HPV-infection in women under the age of 35). Furthermore, few women knew about the screening program being an important supplement to their HPV-vaccine, and therefore did not find the program of relevance to them. Conclusion: Surprisingly, the preliminary results suggest important barriers for participation in cervical screening for women aged 23 to 29 to be insufficient knowledge or lack of knowledge about HPV-infection and the importance of regular smear tests as a supplement to their HPV-vaccine. The women did not perceive the smear test relevant enough to exert action and book an appointment with their GP. Barriers remained similar across age groups within the last 12 years despite health campaigns.