Singapore study identifies barriers to breast and cervical cancer screening
Fear is a major contributor to the low uptake of breast and cervical cancer screening in Singapore, a recent study found. However, not all types of fear have the same impact.
Fear of unnecessary or ineffective treatment, or the inability of screening to detect early cases of cancer proved to impede breast and cervical cancer screening among women in Singapore, with more nonscreeners than screeners believing that mammography or pap smears would result in unnecessary treatment of breast and cervical cancer (39.1 percent vs 27.4 percent; p=0.003).
Nonscreeners also had a higher tendency to believe that early diagnosis would not result in better survival chances (23.5 percent vs 17.6 percent; p=0.048). [Asian Pac J Cancer Prev 2016;17:3887-3895]
In contrast, fear of the financial impact of treatment and likelihood of recurrence did not appear to be barriers to screening where both screeners and nonscreeners alike had similar attitudes on concerns regarding the financial burden of treatment (75 percent vs 77 percent) and cancer recurrence (85 percent vs 83 percent).
Screeners were more likely to be aware of the correct age (52.4 percent) and frequency for screening (24.4 percent) compared with nonscreeners (27.2 and 13.0 percent, respectively; p<0.001).
About 15 percent of screeners and 23 percent of nonscreeners admitted that they would not undergo a pap smear if it was not carried out by a healthcare professional of their preferred gender.
“Our study suggests that gender of the healthcare provider screening the woman is important. For instance, many women in our study were reluctant for a male provider to screen them. Giving women the option to choose the physician who performs their screening exam may be helpful,” said study author Dr Chetna Malhotra, associate professor at the Lien Centre for Palliative Care, Duke-NUS Graduate Medical School, Singapore.
Both screeners and nonscreeners agreed that they would be more likely to undergo screening if the polyclinic they attended scheduled the screening appointment (84.9 percent vs 74.1 percent; p=0.002) or if the entire cost of screening was paid from Medishield (84.2 percent vs 73.2 percent; p=0.002).
“Our study showed that reducing the cost of screening, having polyclinics set screening appointments, Medishield coverage for screening, and lower insurance premiums for screeners can be effective motivators to increase screening uptake,” said the authors.
In an effort to identify the barriers to breast and cervical cancer screening, researchers conducted eight focus groups comprising 64 women. Hypotheses generated through these focus groups were used to devise a survey that was distributed to 801 women aged 25─64 years. The focus groups aimed to assess women’s attitudes towards breast and cervical cancer screening, while the surveys aimed to identify if these attitudes posed barriers or motivations to undergo screening.
There were seven main themes established through the focus groups, ie, fear of cancer diagnosis, knowledge regarding screening, perception of screening procedure or efficacy, cost of screening, perception of risk, and cues to action.
Of the 801 participants, 533 had undergone at least one screening for breast or cervical cancer.
According to Malhotra, GPs can help improve screening rates by targeting the specific fears that prevent screening and by providing women with more information about the correct age and frequency for screening.
“Future studies should focus on testing the effectiveness of various interventions or campaigns to improve screening rates, for instance those that target specific fears that appear to lower uptake of screening or the role of financial incentives or setting up default appointments for screening, especially for those at risk,” she said.