A Review of Cervical Cancer Screening Intervention Research: Implications for Public Health Programs and Future Research

Marcus, Alfred C.; Crane, Lori A.

doi:10.1006/pmed.1997.0251

Cited by 122 publications

(93 citation statements)

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“…Nine interventions were excluded because they were designed to improve follow-up after abnormal Papanicolaou smears, which left 16 studies as a result of the search. 78 -90 Because electronic searches might not identify all relevant studies, 91 reference lists and published reviews of interventions 70,75,76 were reviewed, and a hand search of the journals Preventive Medicine and American Jour- *References 5,6,13,16,17,19,23,24,26,42,43,45,51,[53][54][55]18,22,32,34,36,40,41,45,54,56,57. ‡References 5,6,8,[14][15][16][18][19][20]22,23,40,41,[49][50][51]54,[58][59][60]…”

Section: Study Selectionmentioning

confidence: 99%

“…5,25,38,40,44,59,69 During the past two decades, results from numerous interventions to increase Papanicolaou smear use have been reported. 75,76 These interventions focus on increasing rates of provider recommendation, reducing patient barriers to screening, or both. Two reviews provided descriptive information about interventions published before 1998 and whether they were effective 75,76 but did not provide details about the magnitude of effectiveness.…”

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confidence: 99%

“…75,76 These interventions focus on increasing rates of provider recommendation, reducing patient barriers to screening, or both. Two reviews provided descriptive information about interventions published before 1998 and whether they were effective 75,76 but did not provide details about the magnitude of effectiveness. Because of the large numbers of interventions, particularly in the past several years, and differences in study design, populations, and intervention content, it is difficult to know which interventions are most effective in increasing Papanicolaou smear use.…”

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confidence: 99%

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Effectiveness of Interventions to Increase Papanicolaou Smear Use

Yabroff

Mangan²,

Mandelblatt³

2003

The Journal of the American Board of Family Medicine

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Background: Many women fail to adhere to Papanicolaou smear screening guidelines. Although many interventions have been developed to increase screening, the effectiveness of different types of interventions is unclear.Methods: We performed a systematic review of interventions to increase Papanicolaou smear use published between 1980 and April 2001 and included concurrently or randomized controlled studies with defined outcomes. Interventions were classified as targeted to patients, providers, patients and providers, or health care systems and as behavioral, cognitive, sociologic, or a combination based on the expected action of the intervention. Effect sizes and 95% confidence intervals were calculated for each intervention.Results: Forty-six studies with 63 separate interventions were included. Most interventions increased Papanicolaou smear use, although in many cases the increase was not statistically significant. Behavioral interventions targeted to patients (eg, mailed or telephone reminders) increased Papanicolaou smear use by up to 18.8%; cognitive and sociologic interventions were only marginally effective, although a single culturally specific, sociologic intervention using a lay health worker increased use by 18.0% (95% confidence interval [CI]: 7.6, 28.4). Provider-targeted interventions were heterogeneous. Interventions that targeted both patients and providers did not appear to be any more effective than interventions targeted to either patients or providers alone. One of the most effective interventions, which introduced a system change by integrating a nurse-practitioner and offered same-day screening, increased screening by 32.7% (95% CI: 20.5, 44.9). Screening with regular Papanicolaou smears can decrease not only cervical cancer mortality but also the incidence of invasive disease. Conclusions1,2 Despite increases in recent Papanicolaou smear use during the past two decades, 3,4 with national estimates of approximately 80% within the past 3 years, 4 some women still fail to adhere to recommended Papanicolaou smear screening guidelines, are found to have advanced disease, and die of invasive cervical cancer.27-29 Thus, the potential benefits of routine screening are not being fully realized. Increasing the provision of Papanicolaou smear counseling by primary care providers and, ultimately, routine Papanicolaou smear use are important components of current Healthy People 2010 goals for reducing cervical cancer mortality. 30Physician recommendation is one of the strongest predictors of screening use, 13,17,[31][32][33][34][35][36][37] but in many cases, women report that their provider did not recommend Papanicolaou smears. 5,7,18,38 -45 Explanations for this behavior include lack of time, busy schedules and forgetfulness, 46,47 screening efficacy in the absence of symptoms or concern about proficiency, 31,48 or confusion about conflicting professional recommendations. 46 In the absence of a physician recommendation, patients might assume that screening is unnecessary.Women who do not receiv...

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Section: Study Selectionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Effectiveness of Interventions to Increase Papanicolaou Smear Use

Yabroff

Mangan²,

Mandelblatt³

2003

The Journal of the American Board of Family Medicine

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“…Overall, cognitive interventions are most successful. Marcus and Crane 6 report that in studies in the United States, economic incentives such as subsidies to transportation and vouchers increase follow-up among women from low socioeconomic status, confirming the difficulties these women face when multiple visits are required.…”

Section: Dear Sirmentioning

confidence: 95%

Is a once‐in‐a‐lifetime pap smear the best option for low‐resourced settings?

Robles

2004

Intl Journal of Cancer

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Dear Sir,Cervical cancer mortality has not decreased in developing countries in spite of the availability of screening with conventional cytology for nearly 40 years. Much of the research seeking solutions to this increasing disease burden has focused on coverage of screening and accuracy of screening tests per se. The World Health Organization (WHO) has long advocated for cytology-based organized screening programs. Countries have adopted plans for repeated screening based on successful models in industrialized countries. 1 More recently, owing to the lack of success, the WHO recommends screening at least once in a lifetime at ages 35-40 in low-resourced countries. 2 This being the only opportunity a woman would have for the detection of cervical intraepithelial neoplasia or early detection of cervical cancer, the sensitivity of the test must be high, and most importantly follow-up of women screened positive must be assured. In fact, one of the reasons for the success of screening programs in industrialized countries has been the availability and accessibility of services for diagnostic workup and treatment. Follow-up has not been systematically addressed in developing countries.As part of a larger implementation project, the Pan American Health Organization, which is also the Regional Office of WHO for the Americas, conducted two evaluations of follow-up for women screened positive in clinics serving lowresource settings in Peru and El Salvador. The objective of the assessments was to evaluate whether women screened positive with Pap smears were provided diagnostic and treatment services. In local laboratories of two low-resource areas, cytology reports were reviewed to ascertain the number of women with an abnormal smear during a period preceding the review date by at least 6 months. Information on diagnosis, treatment and disease status was obtained by systematically reviewing medical records from public hospitals and clinics, pathology laboratory registries and death certificates. If no records were found, we visited women at home and used a structured questionnaire to ascertain diagnostic and treatment procedures. Women who had not had any treatment were offered rescreening, diagnosis and treatment at no cost.In the province of San Martin in the Peruvian Amazonia during the period of January 1999 through April 2000, 243 women had a positive smear. One woman was excluded because it had a previous hysterectomy and 9 other lived more than 1 day's travel from the health center so it was not possible to obtain information. In total, 197 (85.1%) of women who screened positive were found. 3 In Chalatenango, El Salvador, 124 women were reported with a positive smear from January through December 2000, and 109 (87.9%) women were found. The proportion of women for whom diagnostic workup was properly documented was very low: 40.8% and 58.1% in Peru and El Salvador, respectively. There were 46 women in Peru and 30 women in El Salvador in whom a positive diagnosis was made, of whom 35 and 26, respectively, completed tr...

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“…Cervical cancer is the third most common cancer in women and while more than 85% of the cases occur in the developing world the burden of disease is also apparent in low-income, minority and low literacy populations of the United States [1][2][3]. In the United States, the annual incidence of cervical cancer is approximately 12,000 and over half of these cases occur in women who have never had a Pap smear, and an additional 20-30% of cases occur in women who have not had a Pap smear in the proceeding five years [4,5].…”

Section: Introductionmentioning

confidence: 99%

Assessing Patient Understanding of the ACOG Abnormal Pap Smear Pamphlet: A Randomized Controlled Trial

Shirazian¹

2014

J Womens Health Care

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Objective: To determine whether the ACOG (American College of Obstetricians and Gynecologists) Patient Education pamphlet -Understanding Abnormal Pap Test Results improves patient understanding of abnormal pap smears for an underserved population in a university-based Gynecology clinic. Methods:We randomized 50 patients presenting to our university-based Gynecology clinic to receive a survey packet containing either the ACOG abnormal pap smear or the ACOG healthy living pamphlet. Patients were given a five question survey before and after reviewing the pamphlet to assess their knowledge regarding Pap smear testing. Understanding of ACOG abnormal Pap smear pamphlet was measured by comparing pre-test and post-test scores.Results: Fifty patients were recruited and 47 surveys completed. There were no demographic differences between the control and experimental groups. The mean baseline pre-test scores were similar among the two groups (89.09% vs. 84.80%). A 10.4% increase in the baseline score was noted on the post-test of the group receiving the abnormal Pap smear pamphlet [p=0.0002], compared to a 1.82% decrease in the post-test of the control group [p=0.5043]. Conclusions:Patients who were exposed to the ACOG abnormal pap smear pamphlet demonstrated superior knowledge about abnormal pap smears when compared to patients in the control group.

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A Review of Cervical Cancer Screening Intervention Research: Implications for Public Health Programs and Future Research

Cited by 122 publications

References 162 publications

Effectiveness of Interventions to Increase Papanicolaou Smear Use

Effectiveness of Interventions to Increase Papanicolaou Smear Use

Is a once‐in‐a‐lifetime pap smear the best option for low‐resourced settings?

Assessing Patient Understanding of the ACOG Abnormal Pap Smear Pamphlet: A Randomized Controlled Trial

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