Which women default from follow-up cervical cytology tests? A cohort study within the TOMBOLA trial

Objective: To identify factors associated with default from follow-up cervical cytology tests.

Methods: A cohort study was conducted involving 2166 women, aged 20–59, with recent low-grade cervical cytology taken within the NHS Cervical Screening Programmes in Scotland and England, and managed by 6-monthly cytology in primary care. For the first (6-month) and second (12-month) surveillance cytology tests separately, women were categorized as ‘on-time attendees’ (attended =6 months of test being due), ‘late attendees’ (attended greater than 6 months after test was due) or ‘non-attendees’ (failed to attend). Multivariate odds ratios (ORs) were computed for factors associated with late and non-attendance.

Results: For the first surveillance test, risk of non-attendance was significantly higher in younger women, those without post-secondary education, and non-users of prescribed contraception. Factors significantly associated with late attendance for the first test were the same as for non-attendance, plus current smoking and having children. The most important predictor of non-attendance for the second surveillance test was late attendance for the first test (OR = 9.65; 95% CI, 6.60–16.62). Non-attendance for the second test was also significantly higher among women who were younger, smokers and had negative cytology on the first surveillance test. Late attendance for the second surveillance test was higher in women who were younger, smokers, had children and attended late for the first test.

Conclusions: Women at highest risk of default from follow-up cytology tend to be young, smoke, lack post-secondary education, and have defaulted from a previous surveillance appointment. Tackling default will require development of targeted strategies to encourage attendance and research to better understand the reasons underpinning default.