Call and recall for cervical cancer screening in a developing country: a randomised field trial.

A randomised field trial was used to assess Mexican women's response to a mailed invitation for a Papanicolaou test. A sample of 4,802 women, 20 to 64 years old, chosen at random from the Mexican Social Security Institute Register were randomly assigned to an intervention and to a control group. A letter of invitation and a reminder were sent to the intervention group. A letter was also sent to the control group at the end of the follow-up period (8.5 weeks) in order to compare the response among women who received a letter in both groups. Cumulative incidence and incidence rates were used to determine the response and the speed of response, respectively. The response among women who had received the letter was 33.5% (efficacy) in the intervention group, while 5.9% (p<0.001) in the control group attended a Papanicolaou test. For the total of women invited, the response was 20.1% (effectiveness) and 3.3% (p<0.001), respectively. The response was greater in rural areas (rural vs. urban/suburban; p = 0.002) and eldest women (50-64 vs. 20-49; p = 0. 02). The response rate was 7 times grater in the intervention than in the control group (RR = 7.1; 95% CI 5.4-9.4; p < 0.001). A mailed invitation to have a Papanicolaou test substantially increases attendance by women who receive it. A mailed reminder improves results. This strategy could be implemented in addition to the ones already in use, mainly among rural and elderly women.

Proposal to institutionalize criteria and quality standards for cervical cancer screening within a health care system.

The uterine cervix is the most common cancer site for females. Approximately 52,000 new cases occur annually in Latin America, thus the need to improve efficiency and effectiveness of Cervical Cancer Screening Programs (CCSP) is mandatory to decrease the unnecessary suffering women must bear. This paper is addressing essential issues to revamp the CCSP as proposed by the Mexican official norm. A general framework for institutionalizing CCSP is outlined. Furthermore, strategies to strengthen CCSP performance through managerial strategies and quality assurance activities are described. The focus is on the following activities: 1) improving coverage; 2) implementing smear-taking quality control; 3) improving quality in interpretation of Pap test; 4) guaranteeing treatment for women for whom abnormalities are detected; 5) improving follow-up; 6) development of quality control measures and 7) development of monitoring and epidemiological surveillance information systems. Changes within the screening on cervical cancer may be advocated as new technologies present themselves and shortcomings in the existing program appear. It is crucial that these changes should be measured through careful evaluation in order to tally up potential benefits.