What attendance rate can be achieved for Pap smear screening?: A case-control study of the characteristics of non-attenders and results of reminder efforts

OBJECTIVE: To understand participation failures in a national Pap smear screening programme by studying characteristics of non-attenders and results of further reminder efforts. DESIGN: A case-control and an intervention study. SETTING: The community health centre in the town of Hafnarfjördur, Iceland. SUBJECTS: The target population comprised 2510 women aged 35-69, who were invited regularly every second year for cervical cancer screening. MAIN RESULTS: 2241 (89.3%) had attended screening during the preceding five years, 102 (4.1%) had never attended, and 167 (6.7%) had attended previously but not during the preceding five years. Women with a mental disorder and those who had never married were more likely not to attend. The most usual explanations given by non-attenders were that they did not like to participate, or they felt they did not need to, some of them because their uterus had been removed. Of the non-attenders 29 (10.8%) came for a Pap smear after repeated reminding efforts. CONCLUSIONS: Total participation rate in cervical cancer screening programmes in Iceland is high. When efforts are taken to lower the non-attendance rate it has to be kept in mind that many women are unwilling or unable to participate in such preventive measures.