With Stoptober smoking cessation campaign starting in October, it is timely to turn our attention to cervical cancer and smoking. In recent months, reduction in cervical cancer incidents has focussed on Human Pappillomavirus and the association between the disease and smoking has become relatively less well known. (1).
A recent study that explored questions of who attends follow-up cervical cytology tests among women with low-grade abnormal cytology has highlighted concerns with smoking behaviour(2). The Trial of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA) trial found that current smokers were 75% more likely to attend late for the first surveillance. In addition, current smokers under the age of 45 were welmost twice as likely not to attend for follow up.
The authors of these findings raise the possibility that smokers may be put off attending a follow-up cytology at their general practice because of the concern that the visit may lead to (unwanted) discussions of their smoking habits. However, the other side of the coin is that the absence of not talking about smoking habit in this setting may lead smokers think that no comment means no health issues, i.e., clean bill of health. How the discussion of smoking habits and advice to stop smoking occurs in a health care setting is of tremendous importance as unsought advice can have implications for the patient-GP relationship, trust and future help seeking for preventive purposes.
It is important that we help women who smoke achieve a ‘coherent’ model of cervical health that includes the link between smoking and cervical cancer. However, to achieve that there is a need to remove barriers to attending follow-up cancer prevention appointments by approaching the smoking habit in a way that is not going to induce guilt, shame, and blame. How we do that in a health care setting requires rigorous empirical testing.
Dr Gozde Ozakinci, PhD, Lecturer in Health Psychology, University of St Andrews
1. Marteau TM, Hankins M, Collins B. Perceptions of risk of cervical cancer and attitudes towards cervical screening: A comparison of smokers and non-smokers. Family Practice. 2002;19(1):18-22.
2. Sharp L, Cotton S, Thornton A, Gray N, Whynes D, Smart L, et al. Which women default from follow-up cervical cytology tests? A cohort study within the TOMBOLA trial. Cytopathology. 2012 Jun;23(3):150-60.