“I feel healthy, I don’t need to go”: Analysis of the cancer screening barrier

BACKGROUND: Cancer screening is an essential tool for reducing cancer mortality. However, screening hesitancy is still a quite common issue in many countries. In this study, we focus on one of the most commonly declared reasons for breast and cervical screening non-attendance among Czech women, which is ‘feeling healthy’. METHODS: We use a mixed-methods approach to investigate the ‘feeling healthy’ barrier, trying to connect three data sources. First, we use a representative sample of Czech women to find the most common reasons for screening non-attendance. Second, we used semi-structured interviews with 10 women to investigate the barriers to screening more deeply. Third, we analyse the data from the European Health Interview Survey (EHIS) 2019, trying to confirm some of the previous findings, using the self-perceived general health variable as a proxy for ‘feeling healthy’. RESULTS: ‘Not experiencing any symptoms’ was the most common reason for cervical (36.7% of non-attendees) and the second most common reason for breast screening (29.2%) non-attendance. Women in the semi-structured interviews talked about that they felt healthy and thus did not feel the urge to attend screening. This feeling was often related to living a healthy life in the form of eating healthy, having enough exercise, not smoking or not drinking. EHIS data show that women with ‘good’ and ‘fair’ self-perceived health compared to those with ‘very good’ health had higher chances of attending both cervical (OR = 1.67, 95%CI 1.32-2.13 and OR = 1.34, 95%CI 1.03-1.74) and breast screening (OR = 2.14, 95%CI 1.76-2.61 and OR = 1.44, 95%CI 1.14-1.82; all models controlled for age and education). CONCLUSIONS: ‘Feeling healthy’ can lead women to believe they do not need to attend cancer screening. Measures should be taken to improve health literacy and cancer awareness to dispel misconceptions about cancer symptoms and encourage women to prioritise screening. KEY MESSAGES: • One of the most common resaons of screening non-attandance is ‘feeling healthy’. • Women with ‘good’ and ‘fair’ self-perceived health compared to those with ‘very good’ health had higher chances of attending both cervical and breast screening.