Differential response to recall in a cervical screening programme

Three years after a normal cervical smear, 1,007 women were followed up to see how they responded to a computer-generated recall letter. Seven women had died and 150 had had interim smears (mainly in association with regular contraceptive or postnatal examination). Of the remaining 850, low response was not related to lower social class in the way initial recruitment to screening is. Working outside the home was more obviously associated with lower response, as wass full-time compared with part-time work. Response was also related to where the first smear was taken (61% of women first examined at a local authority clinic, but only 29% of those from a mobile industrial clinic) and was related to repetition of a familial routine which favoured permanent rather than mobile facilities. Interviews with returners and non-returners showed that over 90% remembered receiving recall letters, so non-response was a conscious decision not to attend. When a first test originated at work, response to recall tended to be poor. Of the non-returners 42%, but only 24% of the returners, had found the first test unpleasant or embarrassing. One-third of non-returners claimed difficulties in finding time, which is in accord with the lower response from full-time workers. Over 90% of those interviewed gave fear or modesty as the reasons why other women had not had a repeat smear. In general, differences in response to a letter inviting women to have a repeat smear are unlike those which characterize recruitment for a first smear. Consistency of experience appears to be strongly favoured in the regular use of cytological screening.