A RANDOMIZED STUDY OF THE IMPACT OF INFORMATION ON POTENTIAL SIDE EFFECTS AND OVERTREATMENT ON INTENT TO PARTICIPATE IN CERVICAL CANCER SCREENING

Purpose: Cervical cancer is the 13^thmost prevalent female cancer in Norway. A national screening program has existed since 1995, but is currently facing declining participation.  Efforts have been made to increase screening participation through the use of information letters. The aims of this study were to evaluate the extent to which additional information regarding overtreatment and potential side effects associated with cervical cancer screening impacts the stated intention of women to participate in screening and pursue recommended treatment, to study women’s preferences regarding the timing of such information, and to explore women’s knowledge about the incidence of cervical cancer.

   Method: A 27 question web-based questionnaire was developed and administered to a panel of Norwegian women aged 25- 69. Respondents were randomized into 3 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 a Pap test is first suggested, 2) when a second test is recommended following the detection of abnormal cells, and 3) when surgical treatment is recommended.  A fourth group  served as a control group and was not provided information about overtreatment or side effects during all three points. This project is part of a larger international comparative study.

   Results: 1,060 women responded to the survey. Additional information about overtreatment and side effects made no significant difference on women’s stated intentions at the first two time points; however it appears to create uncertainty when surgery becomes an option, χ ²(DF=6, N=1060, p=.014). Of the women surveyed, 945 (89.2%) believed that cervical cancer is among the three most common types of cancer among Norwegians. This overestimation is reflected in estimations of incidence, where 302 women (28.5%) correctly identified cervical cancer incidence rates in Norway at approximately 300 cases per year, while 71 (6.7%) underestimated the incidence rate, and 422 (39.8%) placed incidence rates at over 1000 cases a year. Over 80% of women state a preference for receiving information about all potential side effects. 

   Conclusions: Norwegian women overestimate the risk of cervical cancer. Their intention to undergo Pap tests is largely unaffected by the presence of additional information; however, this information may result in greater uncertainty when surgical intervention is suggested.