Easy screening for everyone.

OBJECTIVES: to increase participation of immigrant women at cervical cancer screening programmes. DESIGN: pre-post study to evaluate the efficacy of recall by phone call in immigrant women. SETTING AND PARTICIPANTS: 6,133 immigrant women in Cesena (Emilia-Romagna Region, Northern Italy) who have never made a Pap test in the last three years. MAIN OUTCOME MEASURES: increment of percentage of immigrant women who participated in cervical cancer screening. RESULTS: the recall by phone call and counselling by linguistic mediators to immigrant women from high-pressure to migrate Country moved their participation percentage to cervical screening programmes from 46% (period 2006-2008) to 56% (period 2011-2013). Linguistic mediators contacted 2,131 of these women and they verified that 1,437 of them have not made a Pap test in the last three years. These women were suggested to do the Pap test and 555 of them (39%) did it; these tests cost about 25 euros each for counselling and telephone recall. Pap tests, colposcopies, and histology results permitted to find out and treat: 2 cervical dysplasia of grade I (mild), 3 of grade II (moderate), and 3 of grade III (severe). These 6 women with moderate or severe dysplasia had an average age of 37 years and have never done a Pap test. The cost to find out these cases of moderate or severe dysplasia was about 2,000 euros each. CONCLUSION: the recall phone call and counselling by linguistic mediators is effective and low cost to increase the participation of foreign women in screening programmes.

Follow-up of screening patients conservatively treated for cervical intraepithelial neoplasia grade 2-3.

OBJECTIVES: To evaluate the frequency and correlates of non-adherence to follow-up among patients conservatively treated for CIN2-3. STUDY DESIGN: Study population comprised 1560 patients aged 25-64 years from a screening programme in northern Italy. The regional standard protocol was used as a reference. Multinomial logistic regression analysis was used to estimate the odds ratio probability of a patient being lost to follow-up (no check-ups within 27 months of treatment) or incompletely followed-up (1-3 negative check-ups) versus having 4 negative check-ups. RESULTS: Three hundred twenty-six patients (21%) were lost to follow-up, 678 (43%) were incompletely followed-up, 352 (23%) presented for 4 negative check-ups and 204 (13%) were diagnosed with persistent disease. The probability of no or incomplete follow-up was greater for patients who lived in the urban district, who were treated in private settings (versus screening centres), who exhibited a visibile squamocolumnar junction on pre-treatment colposcopy, who were treated with cold knife excision and local destructive therapy (versus loop diathermy excision), and whose surgical specimens had positive excision margins. CONCLUSIONS: Adherence to the reference protocol was poor. Factors involved in follow-up failures require greater clinical attention.