SAN FRANCISCO—A 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. Holschneider’s 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 prevention.
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 (LEEP).
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 years earlier.
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 women’s 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.
