Information provision in cervical screening in Australia

Jane H Williams, Stacy M Carter and Lucie Rychetnik
Med J Aust 2014; 201 (5): 295-297. || doi: 10.5694/mja13.10999


  • The National Cervical Screening Program and associated state and territory organisations are responsible for promoting cervical screening. Communication via multiple media channels encourages women to be screened. However, some communications are not clear about the risk of cervical cancer and the protective capacity and reliability of the Pap test. The potential harms of screening are rarely presented.
  • Women usually receive Pap tests from general practitioners, who often screen opportunistically during appointments. Screening targets and incentive payments encourage high screening rates.
  • Consent is an important ethical principle in the delivery of all health care. Provision of material information is one of the elements of valid consent.
  • The combination of arguably ambiguous communications, screening participation targets and opportunistic testing under time pressure seems likely to undermine opportunities for women to be informed.
  • Of particular concern are women who are less likely to benefit, those who are more likely to experience harm, and some groups of disadvantaged women.
  • Improved communications could include providing patients with information on the absolute risk of cervical cancer, and the morbidity and mortality benefits and harms of screening. Screening programs internationally have begun providing such information.
  • Areas for further research include the appropriate roles of the programs, screeners and individuals in providing and seeking information. Such work would identify the optimum method for informing women in the screening process.

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  • Jane H Williams1
  • Stacy M Carter1
  • Lucie Rychetnik2

  • 1 Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW.
  • 2 School of Medicine, University of Notre Dame, Sydney, NSW.


We thank Alex Barratt for useful discussions and helpful feedback on an earlier draft of this manuscript. This work was funded by National Health and Medical Research Council (NHMRC) project grant 1023197. Stacy Carter is supported by NHMRC Career Development Fellowship 1032963.

Competing interests:

No relevant disclosures.

  • 1. Beauchamp TL, Childress J. Principles of biomedical ethics. 4th ed. New York: Oxford University Press, 1994.
  • 2. National Health and Medical Research Council. General guidelines for medical practitioners on providing information to patients. Canberra: NHMRC, 2004. (accessed Jul 2014).
  • 3. Skene L, Smallwood R. Informed consent: lessons from Australia. BMJ 2002; 324: 39-41.
  • 4. International Agency for Research on Cancer. IARC handbooks of cancer prevention. Vol. 10: cervix cancer screening. Lyon: IARC Press, 2005.
  • 5. International Agency for Research on Cancer. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. (accessed Jul 2014).
  • 6. Australian Government Department of Health National Cervical Screening Program. National Cervical Screening Program Renewal. (accessed Aug 2014).
  • 7. Australian Institute of Health and Welfare. Cervical screening in Australia 2010-2011. Canberra: AIHW, 2013. (AIHW Cat. No. CAN 72; Cancer Series 76.) (accessed Jul 2014).
  • 8. Raffle AE, Alden B, Quinn M, et al. Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented. BMJ 2003; 326: 901.
  • 9. Barratt A, Mannes P, Irwig L, et al. Cancer screening. J Epidemiol Community Health 2002; 56: 899-902.
  • 10. Kyrgiou M, Arbyn M, Martin-Hirsch P, Paraskevaidis E. Increased risk of preterm birth after treatment for CIN. BMJ 2012; 345: e5847.
  • 11. Arbyn M, Kyrgiou M, Simoens C, et al. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008; 337: a1284.
  • 12. McCaffery KJ, Irwig L, Turner R, et al. Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: an open randomised trial. BMJ 2010; 340: b4491.
  • 13. Akl EA, Oxman AD, Herrin J, et al. Framing of health information messages. Cochrane Database Syst Rev 2011; (12): CD006777.
  • 14. Sasieni P, Castanon A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 2009; 339: b2968.
  • 15. Shaw D, Elger B. Evidence-based persuasion: an ethical imperative. JAMA 2013; 309: 1689-1690.
  • 16. Australian Government Department of Health National Cervical Screening Program. Information for health professionals. Canberra: DoH, 2013. (accessed Nov 2013).
  • 17. Powell N. Cervical screening. Lancet 2000; 355: 411.
  • 18. Raffle AE. Information about screening – is it to achieve high uptake or to ensure informed choice? Health Expect 2001; 4: 92-98.
  • 19. Moyer VA. What we don't know can hurt our patients: physician innumeracy and overuse of screening tests. Ann Intern Med 2012; 156: 392-393.
  • 20. Wegwarth O, Schwartz LM, Woloshin S, et al. Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States. Ann Intern Med 2012; 156: 340-349.
  • 21. Stefanek ME. Uninformed compliance or informed choice? A needed shift in our approach to cancer screening. J Natl Cancer Inst 2011; 103: 1821-1826.
  • 22. Canadian Task Force on Preventative Health Care, Dickinson J, Tsakonas E, et al. Recommendations on screening for cervical cancer. CMAJ 2013; 185: 35-45.
  • 23. Informed Choice about Cancer Screening. NHS cervical screening: helping you decide. London: National Health Service, 2013. (accessed Jul 2014).
  • 24. Entwistle VA, Carter SM, Trevena L, et al. Communicating about screening. BMJ 2008; 337: a1591.
  • 25. Jørgensen K, Brodersen J, Hartling OJ, et al. Informed choice requires information about both benefits and harms. J Med Ethics 2009; 35: 268-269.


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