THE IMPACT OF INFORMATION ABOUT CERVICAL CANCER SCREENING'S SIDE EFFECTS ON INTENTION TO BE SCREENED: A RANDOMIZED SURVEY-BASED STUDY OF NORWEGIAN AND AMERICAN WOMEN

Purpose: Cervical cancer screening has contributed to a decline in incidence in developed countries. While some European countries rely upon national screening programs, US screening is not centralized and uptake is incomplete. In Norway, informational letters have been used to increase screening uptake but it remains unclear when information about side effects of screening and treatment is best presented. This study aimed to: 1) evaluate how the presentation of additional information regarding overtreatment and potential side effects associated with cervical cancer screening in information letters impacts the stated intention of American and Norwegian women to participate in screening and pursue recommended treatment; 2) assess women’s preferences regarding the timing and source of such information; 3) gauge women’s knowledge about cervical cancer incidence.

Method: A web-based questionnaire was developed and administered to samples of screening-eligible women (ages 21-65 in the US and 25-69 in Norway). Participants were randomized to 4 groups based on when in the screening process information regarding overtreatment and the potential impact of surgical treatment on future pregnancy was first introduced: 1) when screening (Pap smear) is first suggested, 2) when a second test is recommended following the detection of abnormal cells, 3) when surgical treatment (conization) is recommended; versus 4) the control group to which no additional information was provided. 

Result: 1,084 American and 1,060 Norwegian women responded to the survey. 770 (71.2%) of the American participants indicated that they would participate in the initial screening round, compared to 920 (86.8%) of the Norwegians. Additional information about overtreatment and side effects did not change American women’s stated intentions to participate at any of the three time points. Among Norwegians, additional information resulted in greater uncertainty about whether they would accept treatment when the surgical intervention was proposed (p=0.011). Of the women surveyed, 945 (89.2%) Norwegians and 657 (60.6%) Americans believed that cervical cancer is among the most common types of cancer nationally, reflecting the general tendency to overestimate cervical cancer incidence.

Conclusion: American and Norwegian women overestimate the risk of cervical cancer. Their intention to undergo screening is largely unaffected by the presence of additional information about side effects; however, for Norwegian women this information may result in greater uncertainty about accepting treatment when surgical intervention is suggested.