Study of the women overdue for a smear test in a general practice cervical screening programme.

Of the 1527 women aged 30-59 years in one general practice who were eligible for a cervical smear examination 196 (12.8%) were overdue for the test. These women were contacted randomly by post or in person to ascertain their reasons for not responding to the practice screening programme. Of 118 women contacted personally 47% had no major objection to the smear test but had a low view of its priority. A further 24% gave incorrect reasons for thinking a smear test was unnecessary while 29% had strong reasons for not wanting to attend and probably never would. Social and medical factors from the medical records were also examined and compared with those of a group of age and sex matched controls. It was found that women overdue for a smear test lived in more ;socially stressed' areas and used their general practitioner much less than the controls. The theoretical upper limit for smear uptake in the practice was calculated to be around 96%. To help achieve this we need to ensure: (1) that all women understand that the test is to detect a stage before cancer; (2) that some women receive more counselling; and (3) that promotional material is directed at the families of women at risk.