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.

Colonoscopic surveillance of first-degree relatives of colorectal cancer patients in a faecal occult blood screening programme.

BACKGROUND: In some Italian areas, colonoscopic surveillance of first-degree relatives (FDRs) of colorectal cancer (CRC) patients is provided as a part of local population-based faecal occult blood test (FOBT) screening programmes. The objective of the present study was to assess the feasibility and early results of this surveillance model. METHODS: Data from district screening centres were used to evaluate the process of identification and selection of eligible FDRs (residence in the Emilia-Romagna Region, age 40-75 years, no recent colonoscopy) of screen-detected CRC patients and the detected prevalence of disease. The probability for an FDR to undergo colonoscopy and to be diagnosed with CRC and advanced adenoma was estimated using the Kaplan-Meier method. The sex- and age-standardised ratio of detected prevalence to that expected based on results from a colonoscopy screening study of the Italian general population was estimated. RESULTS: Between 2005 and 2011, 9319 FDRs of 2437 screen-detected CRC patients (3.8 per patient) were identified and contacted. Their likelihood of being eligible for, and accepting, colonoscopy was 0.11 (95% confidence interval: 0.11-0.12). Among the 926 subjects undergoing colonoscopy, the prevalence of previous negative screening FOBT was 63%. Eleven CRCs (1.2%) and 100 advanced adenomas (10.8%) were detected. The standardised ratio of detected prevalence to that expected was 0.91 (95% confidence interval: 0.19-2.66) for CRC and 1.48 (1.04-2.05) for advanced adenoma. CONCLUSIONS: The procedure of selection of FDRs was extremely ineffective. Due to previous negative screening tests, the prevalence of disease was less than expected. A population-based FOBT screening programme is a highly unsuitable setting for the provision of surveillance to FDRs of CRC patients.