Abstract
Background: Despite overall decreasing mortality from cervical cancer, selected groups of Canadian women continue to have suboptimal access to diagnostic and treatment interventions for cervical cancer. In this paper, we present an evaluation of a colposcopy program developed to improve attendance for colposcopy in a lower socio-economic and immigrant population.
Methods: All women attending the North Hamilton Community Health Centre (CHC) who required colposcopic assessment and were referred to a newly developed colposcopy program based at the CHC were evaluated. Attendance rates for consultation, follow up and treatment in women referred for colposcopy were compared retrospectively for the CHC-based colposcopy program and concurrently with the regional colposcopy clinic (RCC).
Results: Women referred to the CHC colposcopy program had a significant reduction in their no-show rate after the introduction of the locally based colposcopy program (17.2% vs. 1.3%, p<0.01). Comparing the same time periods, there was no significant reduction in the default rate at the RCC (2.5% vs. 3.3%, p=0.21). Despite serving a population of women who were at higher risk for non-attendance, patients at the CHC had a default rate for appointments similar to that of the RCC (1.3% vs. 3.3%, p=0.55) after the introduction of the local colposcopy program.
Conclusions: Lower socio-economic status and immigrant women receiving care from a CHC-based colposcopy program had a significant decrease in their no-show rate for colposcopic evaluation after the introduction of the on-site program. Consideration must be given to locating diagnostic colposcopy programs in settings more accessible to women who require these services the most.
Résumé
Contexte: Malgré la baisse globale de la mortalité due au cancer du col utérin, l’accès de certains groupes de Canadiennes aux mesures de diagnostic et de traitement de ce type de cancer demeure sous-optimal. Nous présentons ici l’évaluation d’un programme de colposcopie visant à améliorer la participation à la colposcopie dans une population immigrante et de faible niveau socio-économique.
Méthode: Nous avons évalué toutes les clientes du Centre de santé communautaire de North Hamilton devant être évaluées par colposcopie et ayant été aiguillées vers un nouveau programme de colposcopie offert sur place, au centre de santé. Les taux de participation aux séances de consultation, de suivi et de traitement chez ces femmes ont été comparés rétrospectivement (pour le programme de colposcopie du centre de santé) et par rapport aux taux observés à la clinique régionale de colposcopie.
Résultats: Les femmes aiguillées vers le programme de colposcopie du centre de santé présentaient une baisse significative de leur taux de non-présentation aux rendez-vous après l’instauration du programme de colposcopie local (17,2 % contre 1,3 %, p<0,01). Sur la même période, il y n’y a pas eu de baisse significative dans le taux de non-présentation à la clinique régionale (2,5 % contre 3,3 %, p=0,21). Bien que le centre de santé desserve une population de femmes ayant un risque de non-participation plus élevé, les patientes du centre affichaient un taux de non-présentation aux rendez-vous semblable à celui des patientes de la clinique régionale (1,3 % contre 3,3 %, p=0,55) après l’instauration du programme de colposcopie local.
Conclusions: Les femmes immigrantes et de faible statut socio-économique qui recevaient des soins dans le cadre d’un programme de colposcopie offert dans leur centre de santé communautaire affichaient une baisse significative de leur taux de non-présentation aux rendezvous de colposcopie après l’instauration d’un programme sur place. Il faudrait donc envisager l’implantation de programmes de colposcopie diagnostique dans des lieux plus accessibles aux femmes qui ont le plus besoin d’un tel service.
Footnotes
Acknowledgements: Dr. Ogilvie received support from the College of Family Physicians of Canada Research Fund. The authors are grateful to Ms. Elizabeth Beader, Executive Director of the North Hamilton CHC for her ongoing commitment to this program.
Reference
- 1.Health Canada. Cervical Cancer in Canada Ottawa: Laboratory Centre for Disease Control, Health Protection Branch. 1998. [Google Scholar]
- 2.SOGC PolicyPractice Guidelines Committee. Management of Abnormal Papanicoloau Smead. Journal of SOG. 2004;20:57–64. [Google Scholar]
- 3.Kinlen LJ, Spriggs AI. Women with positive cervical smears but without surgical intervention. A follow-up stud. Lances. 1978;2:463–65. doi: 10.1016/S0140-6736(78)91457-5. [DOI] [PubMed] [Google Scholar]
- 4.Carmichael JA, Jeffrey JF, Steele HD, Ohlke ID. The cytologic history of 245 patients developing invasive cervical carcinom. Am J Obstet Gynecol. 1984;148:685–90. doi: 10.1016/0002-9378(84)90774-9. [DOI] [PubMed] [Google Scholar]
- 5.Band PR, Gallagher RP, Threlfall WJ, Hislop TG, Deschamps M, Smith J. Rate of death from cervical cancer among native Indian women in British Columbia. CMA. 1992;147:1802–4. [PMC free article] [PubMed] [Google Scholar]
- 6.Hislop TG, Band PR, Deschamps M, Clarke HF, Smith JM, Ng VT. Cervical cancer screenin in Canadian Native women. Adequacy of the Papanicolaou smea. Acta Cytologic. 1994;38:29–32. [PubMed] [Google Scholar]
- 7.Hislop TG, Mumick GC, Yelland L. Invasive cervical cancer among South Asian women in British Columbi. BC Medical. 1995;37:697–99. [Google Scholar]
- 8.Miller AB, Anderson G, Brisson J, Laidlaw J, Le Pitre N, Malcolmson P, et al. Report of a National Workshop on Screening for Cancer of the Cervi. CMA. 1991;145:1301–25. [PMC free article] [PubMed] [Google Scholar]
- 9.Health Canada. Programmatic Guidelines for Screening for Cancer of the Cervix in Canada. Health Canada: Society of Gynecologic Oncologists of Canada; 1998. [Google Scholar]
- 10.Sanders G, Craddock C, Wagstaff I. Factors influencing default at a hospital colposcopy clini. Quality in Health Car. 1992;1:236–40. doi: 10.1136/qshc.1.4.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Laedtke TW, Dignan M. Compliance with therapy for cervical dysplasia among women of low socio-economic status.[see comment. Southern Medical. 1992;85:5–8. doi: 10.1097/00007611-199201000-00003. [DOI] [PubMed] [Google Scholar]
- 12.Lerman C, Hanjani P, Caputo C, Miller S, Delmoor E, Nolte S, Engstrom P. Telephone counseling improves adherence to colposcopy among lower-income minority women. J Clin Onco. 1992;10:330–33. doi: 10.1200/JCO.1992.10.2.330. [DOI] [PubMed] [Google Scholar]
- 13.Lester H, Wilson S. Is default from colposcopy a problem, and if so what can we do? A systematic review of the literatur. Br J Gen Prace. 1999;49:223–29. [PMC free article] [PubMed] [Google Scholar]
- 14.Usha Kiran TS, Jayawickrama NS. Who are the women who default from colposcopy clinic. J Obstet Gynaeco. 2002;22:537–39. doi: 10.1080/01443610000003717. [DOI] [PubMed] [Google Scholar]
- 15.Miller SM, Siejak KK, Schroeder CM, Lerman C, Hernandez E, Helm CW. Enhancing adherence following abnormal Pap smears among low-income minority women: A preventive telephone counseling strateg. J Natl Cancer Inst. 1997;89:703–8. doi: 10.1093/jnci/89.10.703. [DOI] [PubMed] [Google Scholar]
- 16.Marcus AC, Kaplan CP, Crane LA, Berek JS, Bernstein G, Gunning JE, McClatchey MW. Reducing loss-to-follow-up among women with abnormal Pap smears. Results from a randomized trial testing an intensive follow-up protocol and economic incentive. Medical Car. 1998;36:397–410. doi: 10.1097/00005650-199803000-00015. [DOI] [PubMed] [Google Scholar]
- 17.Yabroff KR, Kerner JF, Mandelblatt JS. Effectiveness of interventions to improve follow-up after abnormal cervical cancer screenin. Prev Met. 2000;31:429–39. doi: 10.1006/pmed.2000.0722. [DOI] [PubMed] [Google Scholar]
- 18.Martin BD, Smith WL, Orr P, Guijon F. Follow-up of a decentralized colposcopy program for the investigation and management of cervical intraepithelial neoplasia in the central Canadian Arctic. Int J Circumpolar Healt. 1998;57(Suppl1):406–9. [PubMed] [Google Scholar]
- 19.Healey SM, Aronson KJ, Mao Y, Nicholas F, Mery LS, Ferenczy A, Franco E. Oncogenic human papillomavirus infection and cervical lesions in aboriginal women of Nunavut, Canad. Sex Transm Dis. 2001;28:694–700. doi: 10.1097/00007435-200112000-00006. [DOI] [PubMed] [Google Scholar]
- 20.Ratnam S, Franco EL, Ferenczy A. Human papil-lomavirus testing for primary screening of cervical cancer precursor. Cancer Epidemiol Biomarkers Prev. 2000;9:945–51. [PubMed] [Google Scholar]
- 21.BC Cancer Agency. Cervical Cancer Screening Program Annual Report. Vancouver, BC: BC Cancer Agency; 2000. [Google Scholar]
- 22.Rice J, Feightner J. North Hamilton Community Health Survey. Hamilton, ON: North Hamilton CHC; 1997. [Google Scholar]
- 23.Statistics Canada. Census . Profile of Census Divisions and Subdivisions in Ontario. Ottawa, ON: Minister of Industry, Science and Technology; 1996. [Google Scholar]
- 24.Hislop TG, Clarke HF, Deschamps M, et al. Cervical cytology screening. How can we improve rates among First Nations women in urban British Columbi. Can Fam Phys. 1996;42:1701–8. [PMC free article] [PubMed] [Google Scholar]
- 25.Goel V. Factors associated with cervical cancer screening: Results from the Ontario Health survey. Can J Public Healt. 1994;85:125–27. [PubMed] [Google Scholar]
- 26.Maxwell CJ, Bancej CM, Snider J, Vik SA. Factors important in promoting cervical cancer screening among Canadian women: Findings from the 1996–97 National Population Health Survey (NPHS) Can J Public Healt. 2001;92:127–33. doi: 10.1007/BF03404946. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Yassin AS, Howell RJ, Nysenbaum AM. Investigating non-attendance at colposcopy clini. J Obstet Gynaeco. 2002;22:79–80. doi: 10.1080/01443610120101790. [DOI] [PubMed] [Google Scholar]
- 28.Katz SJ, Hofer TP. Socio-economic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United State. JAM. 1994;272:530–34. doi: 10.1001/jama.1994.03520070050037. [DOI] [PubMed] [Google Scholar]
- 29.Snider J, Beauvais J, Levy I, Villeneuve P, Pennock J. Trends in mammography and Papsmear utilization in Canad. Chron Dis Cal. 1996;17:108–17. [PubMed] [Google Scholar]
- 30.Snider JA, Beauvais JE. Pap smear utilization in Canada: Estimates after adjusting the eligible population for hysterectomy status. Chron Dis Can. 1998;19:19–24. [PubMed] [Google Scholar]
- 31.Stuart GC, McGregor SE, Duggan MA, Nation JG. Review of the screening history of Alberta women with invasive cervical cance. CMA. 1997;157:513–19. [PMC free article] [PubMed] [Google Scholar]
- 32.Parboosingh EJ, Anderson G, Clarke EA, Inhaber S, Kaegi E, Mills C, et al. Cervical cancer screening: Are the 1989 recommendations still valid? National Workshop on Screening for Cancer of the Cervi. CMA. 1996;154:1847–53. [PMC free article] [PubMed] [Google Scholar]
- 33.Grunfeld E. Cervical cancer: Screening hard-to-reach group. CMA. 1997;157:543–45. [PMC free article] [PubMed] [Google Scholar]
- 34.Khanna N, Phillips MD. Adherence to care plan in women with abnormal Papanicolaou smears: A review of barriers and intervention. J Am Board Fam Practic. 2001;14:123–30. [PubMed] [Google Scholar]
- 35.McKee MD, Lurio J, Marantz P, Burton W, Mulvihill M. Barriers to follow-up of abnormal Papanicolaou smears in an urban community health cente. Arch Fam Medicin. 1999;8:129–34. doi: 10.1001/archfami.8.2.129. [DOI] [PubMed] [Google Scholar]