Analysis of three strategies to increase screening coverage for cervical cancer in the general population of women aged 60 to 70 years: the CRICERVA study

Abstract

BackgroundCervical cancer is a frequently diagnosed cancer in women worldwide. Despite having easy preventive and therapeutic approaches, it is an important cause of mortality among women.MethodsThe CRICERVA study is a cluster clinical trial which assigned one of three interventions to the target population registered in Cerdanyola, Barcelona. Among the 5,707 resident women aged 60 to 70 years in the study area, women with no record of cervical cytology over the last three years were selected. The study included four arms: three interventions all including a pre-assigned date for screening visit and i) personalized invitation letter; ii) adding to i) an informative leaflet; and, iii) in addition to ii) a personalized appointment reminder phone call, and iv) no specific action taken (control group). Participants were offered a personal interview about social-demographic characteristics and about screening attitudes. Cervical cytology and HPV DNA test (HC2) were offered as screening tests. In the case of screening positive in any of these tests, the women were followed up until a full diagnosis could be obtained. The effect size of each study arm was estimated as the absolute gain in coverage between the original coverage and the final coverage.ResultsFrom the intervention groups (4,775 women), we identified 3,616 who were not appropriately screened, of which 2,560 women answered the trial call and 1,376 were amenable to screening. HPV was tested in 920 women and cervical cytology in all 1,376. Overall, there was an absolute gain in coverage of 28.8% in the intervention groups compared to 6% in the control group. Coverage increased from 51.2% to 76.0% in strategy i); from 47.4% to 79.0% in strategy ii) and from 44.5% to 74.6% in strategy iii). Lack of information about the relevance of screening was the most important factor for not attending the screening program.ConclusionsThe study confirms that actively contacting women and including a date for a screening visit, notably increased participation in the screening program. Efforts to improve health education in preventative activities are warranted.Trial registrationClinical Trials.gov Identifier NCT01373723. Registered 14 June 2011.

Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial

“…The increase in coverage was of a similar magnitude in the three intervention study arms, although the percentage increase was higher for IG3 with a slightly higher final coverage of 84.4% compared to the overall estimate. These results are consistent with a previous study in Spain in which interventions based on written or telephone briefing were effective to increase a two year cytological coverage compared to the control group [15]. …”

“…Our data is in line with a study in Italy in which 23–58% of the women first invited to participate in the screening, accept, while second remainder for those lost-to follow up dropped substantially the acceptance with a response rate for a cervical pap was 11% and was lower in the elderly population [19]. As we have noted in the analysis of women aged 60 and older [15], the fact that the letters were signed by the family physician and the coordinators of the BHCC, who are generally professionals known by the target population added to the overall coordination of the activity and probably helped to increase attendance as observed by others [18]. However, when women lost to follow-up were contacted by phone at the end of the study only 22% could be contacted (Manuscript in preparation).…”

“…The CRICERVA study [15, 16] is a cluster randomised community-based clinical trial implemented within the Cerdanyola Primary Health Care Service (SAP Cerdanyola). SAP Cerdanyola is a predefined geographical area located in the metropolitan belt of Barcelona, Spain ( S1 File Published protocol S2 File .- Study protocol Spanish, S3 File .- Study protocol English translation, S4 File .- Consort Checklist).…”

Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis

“…The study selection flow diagram is presented in Figure 2. We retained 22 primary studies: 5 of qualitative methodology [29][30][31][32][33], 15 of quantitative methodology [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] and 2 in which both methodologies were used [49,50]. Seventeen studies originate in high income countries (8-USA, 2-Canada, 5-Europe and 2 in Australia) and five in low and middle income countries (1-Mexico, 1-El Salvador, 1-China, 1-India and 1 in Nigeria).…”

“…facilities [29], and type of primary care provider (e.g., family practitioner, gynecologist) [48] can determine screening acceptability. Interventions to increase cervical screening participation include: personalized screening invitation letters [34,37], information leaflets [34], screening reminder phone calls [34], and HPV and cervical cancer prevention education [41,45].…”