SAN FRANCISCOA single-visit cervical cancer screening program
conducted before and after church services may help extend the
benefits of early diagnosis and treatment to underserved populations,
according to research presented at the 30th annual meeting of the
Society of Gynecologic Oncologists.
Christine H. Holschneider, MD, and her associates from UCLA undertook
this study in an effort to extend to Latina women the 70% to 75%
decrease in cervical cancer incidence and mortality that has occurred
overall in the United States over the past few decades.
The higher cervical cancer rate among Latina women is thought to be
due, in part, to financial constraints, lack of medical resources,
and cultural differences. Dr. Holschneiders group addressed
this situation by implementing a single-visit cervical cancer
prevention program conducted on Sundays at an inner city church,
before and after services.
Screening was provided to women over age 18 who were not pregnant and
had not had a Pap smear in the preceding year. At study entry,
participants provided information on personal demographics and
health, as well as on their knowledge of cervical cancer prevention.
Pap smears were done, processed, and interpreted on site, and the
women attended small-group sessions on cervical cancer and its
After the educational session, the women received their Pap results
individually, and those with abnormal cytology underwent immediate
colposcopy with biopsies or a loop electrosurgical excision procedure
The pilot program was held at St. Agatha Parish in South Central Los
Angeles, which consists of about 1,200 families (50% Latino, 35%
African-American, 15% Caucasian or other). The screening program was
held on nine weekends in the summer and fall of 1998. The program was
provided without charge due to funding from the American Cancer
Society and time donated by the UCLA staff.
Regular screening with Pap tests can prevent at least 90% of
all cervical cancers, yet utilization of screening programs is poor,
especially in high-risk patient groups, Dr. Holschneider said.
Numerous barriers to cancer screening have been identified, she said,
including low socioeconomic status, language difficulties, low level
education, lack of phone access, and lack of transportation or child
care. Our goal was to offer screening in a setting that would
overcome most of these practical obstacles to screening, she
said. We went to the patient (at the church); child care was
provided (through the church); and the program was bilingual.
Dr. Holschneider said that 90 of the 98 participants reported Spanish
as their native language, and 59 did not speak English. Fifty-four
had fewer than 6 years of education and 55 were without employment;
78 did not have a regular physician or health insurance; 24 either
had never had a Pap smear or had their last Pap smear more than 5
Half of the women who had no or suboptimal cervical cancer screening
were seen at least once by a physician in the preceding 2 years.
This highlights the fact that we should use all medical
encounters as an opportunity to initate and ideally perform
preventive health care interventions such as cancer screening,
Dr. Holschneider said.
On average, there was a 22.5% improvement in the womens
knowledge score regarding cervical cancer prevention. All
participants were highly satisfied with the program, which was
strongly supported by 92% of nonparticipating members of the
congregation, Dr. Holschneider said.
The mean time for Pap smear staining and diagnosis on site was just
over 20 minutes, and each individual spent about an hour and a half
in the entire program. The staff needed to implement this program
included one gynecologist, one pathologist/cytotechnician, and one
nurse/health educator. Pap smears were collected in the routine
fashion using an Ayres spatula and cytobrush. Pap smears were stained
using a quick-stain method and read on site by a certified
gynecologic cytopathologist. The slides underwent full quality
control review off site.
Dr. Holschneider said that a diagnostic telemedicine hook-up of each
site to a central pathology laboratory would be ideal for use by a
network of community outreach stations and that the UCLA team is
exploring this possibility.