title: 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.
abstract: 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.
  
  
  METHODS
  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%CI 5.7-7.8%). In multivariate analysis, risk of default was significantly raised in those not in paid employment (OR=2.70, 95%CI 1.64-4.43) and current smokers (OR=1.62, 95%CI 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%CI 0.35-0.98). Among the sub-group 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%CI 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.
authors.affiliation: National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork, Ireland. linda.sharp@ncri.ie
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Seonaidh
authors.initials: S
authors.lastname: Cotton
authors.forename: Alison
authors.initials: A
authors.lastname: Thornton
authors.forename: Nicola
authors.initials: N
authors.lastname: Gray
authors.forename: Margaret
authors.initials: M
authors.lastname: Cruickshank
authors.forename: David
authors.initials: D
authors.lastname: Whynes
authors.forename: Ian
authors.initials: I
authors.lastname: Duncan
authors.forename: Robert
authors.initials: R
authors.lastname: Hammond
authors.forename: Louise
authors.initials: L
authors.lastname: Smart
authors.forename: Julian
authors.initials: J
authors.lastname: Little
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003127:Colposcopy / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods; D004651:Employment; D005260:Female; D006801:Humans; D059012:Lost to Follow-Up; D008875:Middle Aged; D012907:Smoking / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears