Studies have suggested that screening for a given type of cancer could be used to promote participation in other types. Specifically, breast cancer (BC) screening tends to have a higher participation rate than do other screenings, such as for cervical cancer (CC) and colorectal cancer (CRC). Generic reasons for this disproportionate participation include embarrassment, discomfort, and logistics.

Understanding Resistance

Given the importance of early detection and early intervention in achieving a positive outcome in cancer treatment, Pia Kirkegaard, PhD, and colleagues developed an interview-based study to explore the barriers to CC and CRC screening with a focus on the practice of distributing self-sampling kits upon attendance of a BC screening. Dr. Kirkegaard and colleagues wrote in the Journal of Medical Screening, “In order to target an intervention to increase joint participation, the reasons for non-participation in CC and CRC screening among BC screening participants needs to be understood.”

The study took targeted women classified as non-participants in CC or CRC screenings who were recruited when attending a BC screening in November 2020. The women were asked to come to a meeting room close to the BC screening facility where they were interviewed in person right after their BC screening or within a week. An online or
telephone option was also offered.

Interview Approach

The interview was inspired by the Health Belief Model and included questions focused on participants’ attitudes toward screening and their reasons for or against obtaining screening. Collected data were analyzed using an approach inspired by the interpretive tradition of ethnography.

Of the 162 women approached to take part in the study, 73 agreed to have their screening status checked. Among them, 22 were non-participants in CC and/or CRC screening. Eleven of the 22 were non-participants in CC screening and expressed some feelings of transgression or exposure as the cause for their non-participation (Table). Some shared that prompting or reminders to get CC screening by their general practitioners were effective motivators. The additional task of booking an appointment was cited as a barrier to undergoing CC screening.

Ease of Use Is Important

Of the 22 study participants, 16 were non-participants in CRC. When asked to compare BC screening with CRC screening, some said BC screening was less troublesome because it requires less mental energy. Some expressed concern about completing the fecal immunochemical test (FIT) incorrectly. They also described having confusion
about the instructions accompanying the FIT, as well as information overload.

For women who were non-participants in both CC and CRC screening, a common explanation given for their inactivity was a lack of urgency in the execution of the screening.

When presented with a scenario in which they would be given the option to do a human papillomavirus (HPV) self-test immediately after BC screening, some women liked the idea of getting it done in a suitable room at the screening center, while others rejected this, opting to have their general practitioner provide a standard CC screening.

Some women said that being reminded about CRC screening and possibly receiving a FIT kit at their BC screening would be meaningful because it would highlight the common denominator of cancer detection in both screenings.

The study concluded that non-participation in CC and CRC screenings was often a passive decision and that procrastination is often a key barrier. Furthermore, Dr. Kirkegaard and colleagues wrote, “nonparticipation increased with a higher number of micro actions that require conscious attention and mental effort, which was more prominent in CC screening and particularly CRC screening compared with BC screening. Promotion of CC and CRC screening when attending BC screening was perceived as meaningful by the women in our study because it would make the screening offers salient again. Interventions to reduce non-participation should aim to critically revise the nature and number of micro actions, provide a suggested deadline, and increase salience.”