Who defaults from colposcopy? A multi-centre, population-based, prospective cohort study of predictors of non-attendance for follow-up among women with low-grade abnormal cervical cytology

Linda Sharp*, Seonaidh Cotton, Alison J Thornton, Nicola Gray, Margaret Cruickshank, David Whynes, Ian Duncan, Robert Hammond, Louise Smart, Julian Little, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Objective: The success of cervical screening relies on women with abnormal cervical cytology attending for follow-up by colposcopy and related procedures. Failure to attend for colposcopy, however, is a common problem in many countries. The objective of this study was to identify factors associated with non-attendance at an initial colposcopy examination among women with low-grade abnormal cervical cytology.

Study design: A cohort study was conducted within one arm of a multi-centre, population-based randomised controlled trial nested within the UK NHS Cervical Screening Programmes. The trial recruited women aged 20-59 years with recent low-grade cervical cytology; women randomised to immediate referral for colposcopy were included in the current analysis (n = 2213). At trial recruitment, women completed a socio-demographic and lifestyle questionnaire; 1693 women in the colposcopy arm were also invited to complete a psychosocial questionnaire, including the Hospital Anxiety and Depression Scale. Women were sent up to two colposcopy appointments. A telephone number was provided to reschedule if necessary. Defaulters were defined as those who failed to attend after two appointments. Logistic regression methods were used to compute multivariate odds ratios (OR) to identify variables significantly associated with default.

Results: 148 women defaulted (6.7%, 95%Cl 5.7-7.8%). In multivariate analysis, risk of default was significantly raised in those not in paid employment (OR = 2.70, 95%Cl 1.64-4.43) and current smokers (OR = 1.62, 95%Cl 1.12-2.34). Default risk deceased with increasing age and level of post-school education/training and was lower in women with children (OR = 0.59, 95%Cl 0.35-0.98). Among the subgroup invited to complete psychosocial questionnaires, women who were not worried about having cervical cancer were significantly more likely to default (multivariate OR = 1.56, 95%Cl 1.04-2.35).. Anxiety and depression were not significantly associated with default.

Conclusions: Women at highest risk of default from colposcopy are younger, not in paid employment, smoke, lack post-school education, have not had children and are not worried about having cervical cancer. Findings such as these could inform the development of tools to predict the likelihood that an individual woman will default from follow-up. Interventions to minimise default also deserve consideration, but a better understanding of reasons for default is needed to inform intervention development. (C) 2012 Published by Elsevier Ireland Ltd.

Original languageEnglish
Pages (from-to)318-325
Number of pages8
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Issue number2
Publication statusPublished - Dec 2012


  • colposcopy
  • abnormal cervical cytology
  • default
  • non-attendance
  • cervical screening
  • PAP-smear
  • health literacy
  • adherence
  • knowledge
  • smoking
  • anxiety
  • adults
  • cost


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