Cervical cancer screening attendance in Japan has stagnated at around 30%. HPV self-sampling may help overcome some of the barriers to screening. However, few studies have investigated barriers to screening in under or never screened Japanese women. We investigated endorsed barriers to cervical cancer screening and compared barriers endorsed by women up-to-date with screening, to those under or never screened.
Anonymous self-administered questionnaires investigating sociodemographic, practical and attitudinal barriers to cervical cancer screening were sent to 473 women in Ebetsu city northern Japan, who were aged 20-44yrs and had requested an HPV self-sampling kit between October 2014 and January 2015. Logistic regression models were used to explore associations between socioeconomic factors, barriers and screening status.The study was approved by the IRB of Hokkaido University Graduate School of Medicine and Hokkaido Cancer Society
In total 392 (82.9%) women returned the self-sampling kit and questionnaire, and 389 were used in the final analysis. Eighty-seven (22.4%) of women were up-to-date for screening, while 135 (35%) and 166 (42.7%) were underscreened and never screened, respectively. While ‘Difficult to get an appointment due to work or childcare’ (75.3%), and ‘Pap smears are embarrassing’ (67.4%) were commonly endorsed barriers, they were not significant predictors of screening attendance. ‘I intend to go, but don’t get round to it’ (OR 3.91, 95% CI 1.61-9.53); ‘I don’t feel at risk for cervical cancer’ (OR 3.71, 95% CI 1.34-10.27); and being a current smoker (OR 3.15, 95% CI 1.27-7.78) were predictors of being underscreened. For never screened, ‘I worry the Pap smear will be painful’ (OR 2.11, 95% CI 1.18-3.80); ‘I don’t feel at risk for cervical cancer’ (OR 3.47, 95% CI 1.19-10.06); being aged 20-24yrs (OR 0.17, 95% CI 0.04-0.81); being single (OR 0.80, 95% CI 0.29-2.22) and being a current smoker (OR 4.80, 95% CI 1.93-12.00) were significant.
While HPV self-sampling may be helpful to reduce some of the barriers associated with cervical screening in Japanese women, more education about actual risk factors for cervical cancer is also essential.