title: Effect of Fee on Cervical Cancer Screening Attendance--ScreenFee, a Swedish Population-Based Randomised Trial.
abstract: BACKGROUND
  Attendance in the cervical cancer screening programme is one of the most important factors to lower the risk of contracting the disease. Attendance rates are often low in areas with low socioeconomic status. Charging a fee for screening might possibly decrease attendance in this population. Screening programme coverage is low in low socio-economic status areas in Gothenburg, Sweden, but has increased slightly after multiple interventions in recent years. For many years, women in the region have paid a fee for screening. We studied the effect of abolishing this fee in a trial emanating from the regular cervical cancer screening programme.
  
  
  METHODS
  Individually randomised controlled trial. All 3 124 women in three low-resource areas in Gothenburg, due for screening during the study period, were randomised to receive an offer of a free test or the standard invitation stating the regular fee of 100 SEK (≈11 €). The study was conducted during the first six months of 2013. Attendance was defined as a registered Pap smear within 90 days from the date the invitation was sent out.
  
  
  RESULTS
  Attendance did not differ significantly between women who were charged and those offered free screening (RR 0.93; CI 0.85-1.02). No differences were found within the districts or as an effect of age, attendance after the most recent previous invitation or previous experience of smear taking.
  
  
  CONCLUSIONS
  Abolishment of a modest screening fee in socially disadvantaged urban districts with low coverage, after previous multiple systematic interventions, does not increase attendance in the short term. Other interventions might be more important for increasing attendance in low socio-economic status areas.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02378324.
authors.affiliation: The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Emilia
authors.initials: E
authors.lastname: Alfonzo
authors.affiliation: The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Andersson Ellström
authors.affiliation: The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Szilard
authors.initials: S
authors.lastname: Nemes
authors.affiliation: The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Strander
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D065006:Papanicolaou Test / Q000191:economics*; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult