Fear that Keeps Women from Cancer Screening is
Fueled by Lack of Information
Studies find that fear can motivate women to either
seek screening or avoid it
June 11, 2009 - Fear plays a major role in whether
women decide to go for cancer screening or not, but healthcare providers
underestimate how much women need to know and wrongly assume that they
will ask for information if they want it. The studies included women of
all ages, from 14 year-old teenagers to women in their eighties.
Those are the two key findings from a study
published in the June issue of the UK-based Journal of Advanced
Nursing.
(See
screening recommendations by American Cancer Society below this news
report.)
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U.S. researchers Dr. Kelly Ackerson and Dr.
Stephanie Preston reviewed 19 studies that covered the period 1994 to
2008. The data explored the attitudes of 5,991 women to breast and
cervical cancer screening.
"Our review showed that fear could motivate women
to either seek screening or to avoid screening" says nurse researcher
Dr. Ackerson, an Assistant Professor at Western Michigan University,
USA.
"Some women complied because they feared the
disease and saw screening as routine care, but other women feared
medical examinations, healthcare providers, tests and procedures and
didn't seek screening if their health was good.
"Lack of information was a big barrier. It was
clear from our review that very few women understood that cervical smear
testing aims to identify abnormal cells before they become malignant and
that breast screening can detect cancer in the early stages when
treatment is most effective.
"The review also highlighted that many women had
misconceptions about breast and cervical cancer and who was at risk. For
example, some women felt they did not need breast or cervical screening
after a certain age and some believed that they could not develop
cervical cancer if they weren't in a current sexual relationship.
"Women who did not have a family history of cancer
were also less likely to think they were at risk. Because there has been
a lot of publicity about the role that family history can play in breast
cancer, many women assumed wrongly that the same family patterns can
apply to cervical cancer."
Figures from the USA and UK show that there is a
big gap between the number of women invited for screening and the number
who actually attend.
In 2007 the Centers for Disease Control and
Prevention in America estimated that 25 per cent of women aged 40 plus
had not had breast screening in the last two years and 16 per cent aged
18 and over had not had a cervical smear in the last three years.
Cancer Research UK figures for the same year
suggest that 4.4 million women were invited for cervical smears but only
3.6 million (82 per cent) attended.
Breast cancer rates are similar in both countries,
despite differently funded healthcare systems and screening criteria,
but a lower percentage of UK women die from cervical cancer.
The researchers have come up with three key
recommendations as a result of their review:
Nurses should promote screening by educating women
of the benefits of breast and cervical screening even when they do not
ask for information.
Initiatives aimed at increasing uptake rates should
focus on women's fears about the procedure or a possible positive
result.
Public health messages need to specifically target
women who do have access to healthcare but fail to undergo routine
testing.
"Nurses have a key role to play in addressing the
fears and lack of knowledge that women have when it comes to screening
for breast and cervical cancer" concludes Dr Ackerson.
"They need to help women understand both the risks
and benefits of screening so that they can make informed choices about
whether or not they want to be tested."
Background Information:
Source: A decision theory perspective on
why women do or do not decide to have cancer screening: systematic
review. Ackerson K and Preston S. Journal of Advanced Nursing.
65.6, 1130-1140. (June 2009).
Journal of Advanced Nursing is read
by experienced nurses, midwives, health visitors and advanced nursing
students in over 80 countries. It informs, educates, explores, debates
and challenges the foundations of nursing health care knowledge and
practice worldwide. Edited by Professor Alison Tierney, it is published
24 times a year by Blackwell Publishing Ltd, part of the international
Blackwell Publishing group.
www.journalofadvancednursing.com
Wiley-Blackwell is the international scientific,
technical, medical and scholarly publishing business of John Wiley &
Sons, with strengths in every major academic and professional field and
partnerships with many of the world's leading societies. Wiley-Blackwell
publishes over 1,400 peer-reviewed journals as well as 1,500+ new books
annually in print and online, as well as databases, major reference
works and laboratory protocols. For more information, please visit
www.wileyblackwell.com or
www.interscience.wiley.com
Screening Recommendations by American Cancer Society
The American Cancer Society is generally recognized
as the authority on cancer screening recommendations. Below are a few of
those recommendations, chosen for their application to women and older
women, in particular. For more detailed and updated information see a
link to the ACSs Web page on screening recommendations below
abbreviated list.
Cancer-related checkup
For people aged 20 or older having periodic health
exams, a cancer-related checkup should include health counseling, and
depending on a person's age and gender, might include exams for cancers
of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as
well as for some non-malignant (non-cancerous) diseases.
Special tests for certain cancer sites are
recommended as outlined below.
Breast cancer
Yearly mammograms are recommended starting at age
40 and continuing for as long as a woman is in good health.
Colon and rectal cancer
Beginning at age 50, both men and women at average
risk for developing colorectal cancer should use one of the screening
tests below. The tests that are designed to find both early cancer and
polyps are preferred if these tests are available to you and you are
willing to have one of these more invasive tests. Talk to your doctor
about which test is best for you.
Tests that find polyps and cancer
● flexible sigmoidoscopy every 5 years*
● colonoscopy every 10 years
● double contrast barium enema every 5 years*
● CT colonography (virtual colonoscopy) every 5
years*
Tests that mainly find cancer
● fecal occult blood test (FOBT) every year*,**
● fecal immunochemical test (FIT) every year*,**
● stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are
positive.
**For FOBT or FIT used as a screening test, the take-home multiple
sample method should be used. A FOBT or FIT done during a digital rectal
exam in the doctor's office is not adequate for screening.
Cervical cancer
● All women should begin cervical cancer
screening about 3 years after they begin having vaginal intercourse, but
no later than when they are 21 years old.
● Women 70 years of age or older who have had 3
or more normal Pap tests in a row and no abnormal Pap test results in
the last 10 years may choose to stop having cervical cancer screening.
Endometrial (uterine) cancer
The American Cancer Society recommends that at the
time of menopause, all women should be informed about the risks and
symptoms of endometrial cancer, and strongly encouraged to report any
unexpected bleeding or spotting to their doctors.
>>
Click here to
more detailed information at American Cancer Society.
