Low-income women with abnormal Pap tests who participated in a program that combines screening and treatment in one visit had a higher rate of treatment and follow-up than women who did not participate, according to a study in the November 2 issue of JAMA: The Journal of the American Medical Association.
Cervical cancer incidence rates in the United States have progressively declined because of the widespread application of cervical cancer screening and treatment of precancerous lesions, according to background information in the article. The majority of cervical cancers diagnosed in this country are among women who have never received a Papanicolaou test or who are noncompliant with screening and follow-up. The incidence of cervical cancer is higher among low-income and minority women. The barriers to cervical cancer screening and management include poverty, lack of health insurance, limited transportation, language difficulties, lack of child care and lack of telephone access. The researchers believe that the usual approach to cervical cancer screening, diagnosis, and management accentuates some of these barriers because it is cumbersome and expensive, ordinarily involving multiple clinic or hospital visits and requiring a period of months to complete. Previous research has reported that between 20 percent and 50 percent of women with abnormal Papanicolaou test results do not have follow-up.
Wendy R. Brewster, M.D., Ph.D., of the University of California, Irvine, and colleagues developed a cancer control program to simplify cervical screening and management of high-grade cervical dysplasia among predominantly Latina women from underserved communities. They hypothesized that women who received results and explanations about the importance of follow-up for an abnormal Papanicolaou test result on the same day as the test would be more likely to follow up. The randomized trial included 3,521 women aged 18 or older recruited between January 1999 and April 2002 from U.S. community health centers, located in predominantly Latino underserved areas.
Women randomized to usual care (n=1,805) were discharged immediately after examination. Women randomized to the single-visit group (n=1,716) remained at the clinic until the results of their conventional Papanicolaou test were available. Large loop electrosurgical excision procedure was performed in single-visit patients with either a diagnosis of a high-grade squamous intraepithelial lesion (HGSIL)/atypical glandular cells of undetermined significance (AGUS) or suspicion of carcinoma. All other patients with abnormal Papanicolaou test results were referred to abnormal cytology clinics or elected to receive follow-up care outside the study's medical system.