Abstract
McCartney and Bewley 1 make a valid point that ‘adults must be treated as competent’ and that the decision to attend for screening must be a choice – we absolutely agree. However, they have misunderstood our methods. We interviewed a population-based sample, and assessed endorsement of potential barriers to cervical screening attendance in all women, not just those who were overdue for screening. At no point did we ask women to ‘explain their behaviour in not attending’, and this is demonstrated by the fact that almost as many regular attenders endorsed the statement that smear tests are embarrassing as did non-attenders.
We acknowledge that for some women, the decision not to attend screening is a legitimate, informed choice. But the high endorsement of practical barriers in our study points to the fact that many women do want to go for screening, but are prevented from doing so by practical factors. Although the benefits of screening for any one individual are small, the reduced mortality rate from cervical cancer in the UK over the last 30 years points to the success of the screening programme, 2 and it is well-documented that women who do not attend regularly for screening are at increased odds of developing cervical cancer. 3
To suggest that the decision not to attend for screening, or not to vote, is based on a ‘realistic statistical appraisal’ of the efficacy of these behaviours is too simplistic. It overlooks the fact that human behaviour is highly complex, and is affected by a multitude of psychological and situational factors, as well as rational decision-making. While it is, of course, our duty to ensure that women are able to make an informed choice about screening, we must also make sure that if they are positively inclined towards attending, it is as easy as possible for them to do so.