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‘It has saved thousands of lives, so why change it?’ Content analysis of objections to cervical screening programme changes in Australia
  1. Helena M Obermair,
  2. Rachael H Dodd,
  3. Carissa Bonner,
  4. Jesse Jansen,
  5. Kirsten McCaffery
  1. School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Rachael H Dodd; rachael.dodd{at}


Objectives The incidence and mortality of cervical cancer have halved since introduction of the Australian cervical screening programme in 1991, involving 2-yearly Pap smears from ages 18–69 years. In 2017, the programme changed to 5- yearly primary human papillomavirus (HPV) testing for women aged 25–74 years. This study investigated reasons for opposition to the renewed screening programme within the open-ended comments of an online petition, ‘Stop May 1st Changes to Pap Smears—Save Women’s Lives’, opposing the changes, which received over 70 000 signatures and almost 20 000 comments.

Methods Content analysis of a random sample of 2000 comments, reflecting 10% of the 19 633 comments posted in February–March 2017.

Results Nineteen codes were identified, reflecting four themes: (1) valuing women’s health and rights, (2) political statements, (3) concerns about healthcare funding cuts and (4) opposition to specific components of the new screening programme. The most prevalent codes were: placing value on women’s health (33%), concerns about increasing screening intervals (17%) and opposition to the changes related to personal experiences with cervical cancer or cervical abnormalities (15%). Concern about the key change in technology (HPV testing instead of Pap smears) was expressed in less than 3% of comments, and some opposition to the changes from health professionals was noted.

Conclusions Screening changes within this selected group were perceived as threatening women’s health, as a political policy created by male decision-makers and as a cost-cutting exercise. Many commenters were concerned about increased screening intervals and later screening onset, but little opposition was expressed regarding the testing technology itself. This analysis may inform public education and communication strategies for future changes to cervical screening programmes internationally, to pre-emptively address specific concerns about the changes.

  • public health
  • gynaecological oncology
  • health policy
  • qualitative research
  • preventive medicine

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  • Contributors HMO acquired the dataset, analysed and coded 2000 comments, and drafted the manuscript. RHD was involved in the conception and design of the work, analysed and coded 2000 comments and drafted the manuscript. CB, JJ and KM were involved in the conception and design of the work, and drafting the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The research was supported by a NHMRC Program Grant (APP1113532).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The University of Sydney Human Research Ethics Committee reviewed and approved this study (project number 2017/300).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data used for this manuscript are freely available online at the following website: