[The STF Project: Female Tumor Screening]. / Il progetto STF--Screening Tumori Femminili.

A pilot study has been carried out to evaluate women's compliance to a screening program for cervical cancer. The study, initiated in 1994, was performed in conjunction with the ACRO project of the CNR by the Italian National Health Institute, in collaboration with La Sapienza University of Rome and the National Institute for Cancer Research in Genoa. A preliminary telephone survey was carried out on a sample of 400 women (200 in Rome and 200 in Genoa) to assess, among other factors, their attitude towards the screening program. Afterwards, an ad hoc advertising campaign was launched and 21,827 women, randomly chosen from the register office's lists, were sent a personal invitation to participate in the screening. Most women showed interest in attending the screening program at the interview, but the percentages of participation were low (25.7% in Genoa and 27.3% in Rome). On the other hand, a high percentage of women who participated in the screening had already had a Pap test in the previous three years (Genoa, 73%; Rome, 76%). The recruiting techniques that were used in this study, and that are commonly used, do not seem to reach the core of the target population for cervical screening, i.e. women who have never had a Pap test or who had a Pap test more than 5 years earlier. New methods of recruiting aimed at categories at risk and based more on direct contacts need to be developed.

Attitude of women towards early cancer detection and estimation of the compliance to a screening program for cervix and breast cancer.

Before the start of a feasibility study for cervical and breast cancer screening in two towns (Genoa and Rome) in Italy, a random sample (N = 349) of the target population was interviewed with the aim of evaluating (i) the degree of knowledge as to the purpose of the screening tests; (ii) the attitude towards early detection of these cancers; and (iii) the potential compliance to the program. Pap test: 48.7% of women were correctly informed about the object of the test; information was associated with the degree of education (p < 0.0001). Periodic Pap test was reported by 77.9% of women: the proportion was higher among younger (p = 0.013) and married women (p = 0.001). A 1-year interval between two tests was more frequently reported by younger women (p < 0.001). Estimated participation in the cervical cancer screening program was 63.3%. Increasing age (OR = 0.78; CI = 0.6-1.0), the married status (OR = 0.39; CI = 0.18-0.83) and lack of knowledge of the object of the test (OR = 0.47; CI = 0.25-0.87) hindered participation in the program. Mammography: 53.3% of women reported that it is a method used for early detection of breast cancer. Well-educated women were more likely to be correctly informed (p < 0.0001). Previous mammography was reported by 49.3% of women aged 50 to 69 years who never experienced breast cancer symptoms; married women more frequently reported having had the test (p = 0.02). Estimated participation in the breast cancer screening program was 59%. Women aged 60 years and over were less prone to participate (OR = 0.44; CI = 0.22-0.89). Increasing age was the most relevant barrier to participation in screening programs, and strong efforts should be made to involve older women, due to their greater chance of getting cancer.

Planning of a screening programme for cervical cancer in Liguria and evaluation of the attitude of the female population towards cancer detection.

In 1990 an investigation aimed at evaluating the possibility of organizing a regional screening programme for the early detection of cervical cancer was carried out in Liguria. Information on resources available for early detection of cervical cancer was obtained from 12 of 20 Public Health Units; a screening programme was feasible in 8 of them. The number of Pap tests examined was evaluated for 6 of 20 cytology laboratories. Only one laboratory examined more than 20,000 Pap tests in 1989 and, according to the international guidelines, can be a referring centre for screening. However, no information was available concerning inter- and intralaboratory quality control programmes. In the same period a population-based survey was carried out using a self-administered questionnaire in order to evaluate the attitudes of women towards cervical cancer prevention. A total of 1,454 of 4,197 women (35%) participated in the study. Younger, well educated women employed in non non-manual work were more likely to participate in the study. About 65% of the respondents had satisfactory practices with regards to the Pap test, suggesting a strong self-selection that probably resulted in a sample of women more health-conscious than the general population. In conclusion, our results suggest that major interventions should be carried out in the Public Health Units to direct resources to the needs of the population. In addition, new educational methods should be adopted to reach selected population groups to encourage them to have a Pap test performed on a regular basis.