Adherence to Pap Smear Testing Not Influenced by Free or For-a-fee Among Low-income Swedish Women

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Offering free pap smears for cervical cancer screening did not increase pap smear frequency in low income women, even though low income and socioeconomic status are more likely to predict women skipping pap smears.1

Researchers examined how abolishing the fee affected the frequency of pap smears. This research took place in a low-income area of Gothenburg, Sweden, where women had been paying a fee for pap smears.

This study, published in PLoS One, was an individually randomized, controlled study examining 3124 women from 3 different low-income regions of Gothenburg, Sweden, in the first half of 2013. Women were offered either a free test or a test for the standard fee, the equivalent of just over $12 US.

Rates of receiving a pap smear were not different between the free and the fee groups (relative risk 0.93; 95% CI 0.85-1.02), and no correlations with age or previous pap smear history existed. Undergoing a pap smear was recorded when a woman accepted the invitation within 90 days of its receipt.

The researchers emphasized that these results do not support increasing fees for pap smears. They suggest instead allocating available resources for low-income women to health care efforts other than covering pap smear fees.

"This result should not be used as an argument to raise fees or introduce fees where it has previously been free," explained Björn Strander, MD, PhD, director of cervical cancer screening at the Oncology Center, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, and study leader.

"You have to remember that the fee is low, €11, and a higher fee can very well be a deterrent. But the results teach us that funds that could be used to remove this low fee, could better be used elsewhere. Making it easier for women to get pap test screening is important and there are other measures that have been proven very effective."


1. Alfonzo E, Andersson Ellström A, Nemes S, Strander B. Effect of fee on cervical cancer screening attendance-ScreenFee, a Swedish population-based randomised trial [published online ahead of print March 17, 2016]. PLoS One. doi:10.1371/journal.pone.0150888.

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