Information provision in cervical screening in Australia

Abstract

• The National Cervical Screening Program, and associated state and territory organisations, are responsible for promoting cervical screening. Communication via multiple media channels encourages women to be screened. • Some communications are not clear about misrepresent the risk of cervical cancer and the protective capacity and reliability of the Pap smear. The potential harms of screening are rarely presented. • Participation is a key performance indicator for the Program. • Women receive Pap tests from clinicians, mostly general practitioners (GPs) who often screen opportunistically during already-busy appointments. Incentive Payments encourage high screening rates. • Consent is an important ethical principle in the delivery of all health care. Provision of material information is one of the elements of valid consent. • The combination of arguably ambiguous misleading communications, screening participation targets, and opportunistic testing under time pressure seems likely to undermine opportunities for women participating in the cervical cancer screening program to be informed. • Of particular concern are women who are less likely to benefit, women who are more likely to experience harm, and some groups of disadvantaged women. • Improved communications could include the absolute risk of cervical cancer and the morbidity and mortality benefits and harms of screening. Screening programs internationally have begun providing such information. • Performance indicators could value evidence of discussion or informing. • Areas for further research include the appropriate roles of the program, screeners, and individuals in providing and seeking information. Such work would identify the optimum method for informing women in the screening process.