ABSTRACT
A pilot cervical screening program was established in 1993 in a french administrative area, the "département du Doubs". We report a program set-up, screening activities and the main results obtained within three years. The responsibility for its organization was assigned to a multidisciplinary health professional committee and screening policy was determined according to the recommendations of the consensus conference held in Lille. A record of all smears taken from women in the Doubs county was established by centralizing data from all regional cytopathology laboratories. Within three years, 57% of all women in the 20 to 65 years age group had at least one smear. Prevalence rates of pathological and unsatisfactory smears slightly increased during this period. Among women with smear showing high grade intraepithelial lesion, 94% had a histological test which confirmed the lesion for 81% of the women concerned. Fifty-eight per cent of the women had a second smear within 3 years but only 49% of the women had a new smear after a first unsatisfactory smear. Measures to be implemented in order to improve these results are discussed.
Subject(s)
Mass Screening/organization & administration , Uterine Cervical Neoplasms/diagnosis , Adult , Aged , Female , France/epidemiology , Humans , Incidence , Middle Aged , Organizational Policy , Patient Care Team/organization & administration , Pilot Projects , Program Evaluation , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears/standardsABSTRACT
OBJECTIVES: To examine the relationship between deprivation and attendance to cervical cancer screening. METHODS: Three deprivation indices (Carstairs, UnderPrivileged Area, Department of Environment) were calculated for women aged 25-65 attending a 1993-95 cervical cancer screening program (Doubs "département", France), with 594 municipalities as statistical units. Weighted multivariate linear regressions were performed, with attendance rate as the dependent variable, and the three deprivation indices in turn as independent variables along with women's mean age, average net income, density of (para)medical amenities, density of population and proportion of women. RESULTS: Per municipality women were numbered 1-29,822 (mean 210). In multivariate models, the three deprivation indices were negatively linked to attendance rate, and so were mean age of women and density of population. Average net income, proportion of women, and density of (para)medical amenities (nurses, laboratories, ambulances, physicians, dentists) were positively associated with attendance rate. CONCLUSIONS: In early stages, cervical cancer screening programs should account for populations living in deprived areas, through focused health promotion efforts and easier access to screening facilities.
Subject(s)
Mass Screening/statistics & numerical data , Patient Compliance/statistics & numerical data , Poverty , Uterine Cervical Neoplasms/diagnosis , Adult , Aged , Analysis of Variance , Cohort Studies , Female , France , Humans , Linear Models , Middle Aged , Multivariate Analysis , Poverty/statistics & numerical data , Residence Characteristics , Sampling Studies , Socioeconomic FactorsABSTRACT
OBJECTIVE: To analyze women participation and test results during the 1993 to 1997 screening cycle. METHODS: The program was managed by a multidisciplinary health professional committee who determined the screening policy according to the recommendations of the French consensus (Lille 1990). All smears and cervical histological tests taken from women living in the area were collected by centralizing data from cytopathological laboratories. RESULTS: Within five years, 71% of women in the 20-65 years age group had at least one smear. After the age of 29, participation rate decreased with age. The prevalence of unsatisfactory smears was 1.4/1000 and 3% of screened women had an abnormal smear (squamous intraepithelial lesion or carcinoma). A follow-up test was registered for 83% of women with an abnormal smear. Lesions were confirmed by histology in 77% of women with a histological test. CONCLUSION: In the context of initiating a national screening program, our study shows that implementing women invitation and follow-up and quality control procedures are necessary to improve the results of ongoing cervical cancer screening.
