Invitation and reminder letters increase women's take up of pap tests in developing countries, especially in rural areas and among older womenCall and recall for cervical cancer screening in a developing country: A randomised field trial.
- Rose, Joanne
- Torres-Mejia, G
- Salmeron-Castro, J
- Tellez-Rojo, MM
- Lazcano-Ponce, EC
- Juarez-Marquez, SA
- Torres-Torija, I
- Gil-Abadie, L
- Buiatti, E
BACKGROUND
Of the 500,000 estimated new cases of cervical cancer every year, 80% are from developing countries. Papanicolaou test screening programmes can decrease the incidence and mortality of cervical cancer, but attendance is low, especially in developing countries. In Mexico, screening programme coverage is around 20%.
OBJECTIVE
To determine the efficacy of sending an individual invitation letter on use of the pap test.
SETTING
Morelos, South Mexico, 1997.
METHOD
Randomised field trial.
LITERATURE REVIEW
None stated. 34 references.
PARTICIPANTS
4802 of 103,978 women aged 20-64 were randomly chosen and stratified by age and location, from the Social Security Register.
INTERVENTION
A letter of invitation for a pap test and a reminder versus no initial letter. The letter briefly outlined the benefits of pap testing and contained a personal invitation to be tested within 5 weeks of receipt. A survey and postage-paid reply envelope were also provided for those who chose not to have the test. Those who did not respond within 1-2 weeks were sent a reminder letter. After the follow-up period (8.5 weeks) letters were also sent to the control group.
OUTCOMES
Test attendance; speed of response.
MAIN RESULTS
33.5% of those who received an invitation letter compared to 5.9% of controls attended a test (P < 0.001, see Table 1). The response was greatest in rural areas (P = 0.002) and among women aged over 50 (P = 0.02). The mean time between invitation receipt and test attendance was 49 days. Reminder letters had a significant effect, raising test participation from one in five to one in three. At the end of the follow-up period those who had received a letter were 7 times more likely to have had a test (95% CI 5.4 to 9.4). Those who were invited but chose not to have a test largely declined because they had already been tested in the last 12 months (74%).
AUTHORS' CONCLUSIONS
Mailing women an invitation to have a pap test increases their participation. This is a simple strategy which could effectively be used to enhance screening rates, especially for older women and those in rural areas.