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19 Opportunity to reduce overdiagnosis and overtreatment of cervical abnormalities: de-intensifying the australian national cervical screening program
  1. Rachael Dodd,
  2. Brooke Nickel,
  3. Jolyn Hersch,
  4. Carissa Bonner,
  5. Sally Wortley,
  6. Kirsten McCaffery
  1. University of Sydney, Sydney, Australia


Objectives Reductions to the Australian Cervical Screening program from two yearly to five yearly primary HPV screening, from the increased age of 25 (previously 18), offers an opportunity to reduce overdiagnosis and overtreatment of cervical abnormalities and its associated harms. The changes, implemented in December 2017, will likely reduce overtreatment particularly in women under 25 years, for whom HPV is usually transient and cervical abnormalities are more likely to regress. Strong resistance has been demonstrated previously in both the US and UK, when efforts have been made to de-intensify screening programs. We explored the views and attitudes of screening aged women to the changes, and their understanding of the rationale behind the changes with the aim to develop public communication that mitigates concerns about de-intensifying cancer screening programs.

Method Six focus groups were conducted in November 2017 in the Sydney area, with 49 women aged 18–74, recruited through random digit dialling. Eligible women had not previously been diagnosed with cervical cancer or had a hysterectomy. Focus groups were structured around a presentation of information about the changes to the cervical screening program, with discussions of the information facilitated throughout. The focus groups were analysed thematically.

Results Only a third of women had heard something about the changes, mainly either the increased interval between tests or the increased starting age. Questions were raised about the test, with awareness of human papillomavirus (HPV) evidently limited. Explaining clearly the difference between the two tests (Pap smear vs HPV test), and that the procedure is exactly the same for both tests, was important to women. Understanding of the new test was key to alleviate concerns about the extended screening interval. Communicating the rationale of the changes to women, in a clear and coherent way, was paramount for acceptance of the new program. Information presented about the potential of over-detection and unnecessary tests did not appear to concern women greatly, but one group showed some surprise shown of the harms that could result from treatment of cervical abnormalities.

Conclusions De-intensifying screening programs should be accompanied by clear and coherent communication of the changes, to limit negative concerns from the public. Communicating about over-treatment in this cohort of women did not appear to spark concern, but perhaps further focus on communication of this would create a greater understanding in women about the benefits and harms of screening. The findings of this study contribute to an understanding of what information women seek about changes to the Australian Cervical Screening Program.

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