Investigation of non-responders at a cervical cancer screening clinic in Manchester.

Uptake of cervical cytology screening in a Manchester practice has been very low (14%) in spite of the family practitioner committee introducing a call and recall system. A questionnaire was used to investigate the attitudes of non-responders, who were all from social classes IV and V. Attendance was found to be inhibited by a high level of anxiety about the test and about cervical cancer, by erroneous beliefs, and by concurrent family difficulties. More than half the non-attendance was directly attributable to administrative errors, which resulted in appointments being sent to wrong addresses or to inappropriate people (four after hysterectomy, 10 who had had recent smears). These matters require urgent attention. Several simple measures might improve attendance at clinics, follow up of patients, and attitudes toward screening: invitations to attend the clinic, a register of patients and results, a simpler version of the leaflet, use of well known personalities to promote cervical screening, health education campaigns, and regular evaluation of records.