CMAJ/JAMC Letters
Correspondance

 

Screening for cervical cancer

CMAJ 1998;158:301
See response from: E. Grunfeld
Although we agree with many of the points raised in the editorial "Cervical cancer: screening hard-to-reach groups" (CMAJ 1997;157[5]:543-5 [full text / résumé]), by Dr. Eva Grunfeld, the overall impression is that there is still some doubt about the success of Pap testing in reducing the incidence of and mortality rates associated with cervical cancer. The editorial emphasizes recruitment of underscreened and hard-to-reach groups, although Grunfeld acknowledges that 50% of women with invasive cancer of the cervix have undergone Pap testing. In their article "Review of the screening history of Alberta women with invasive cervical cancer" (CMAJ 1997;157[5]:513-9 [full text / résumé]), Dr. Gavin C.E. Stuart and colleagues document factors associated with the development of cervical cancer in such women. They stress the need for high-quality laboratory and information systems and a program to ensure that all women at risk undergo at least one Pap test and enter a cervical screening program.

After the last Canadian Workshop on Cervical Screening,1 the Cervical Cancer Prevention Network (CCPN) was formed to facilitate the development of provincial screening programs for cervical cancer. Three working groups have been created, one each for information systems, quality management and recruitment. I am writing in my capacity as chair of the Recruitment Working Group.

With support from Health Canada, we commissioned a literature review to identify successful strategies that targeted women aged 15 to 69 years, hard-to-reach women and health care professionals. The review, which will be submitted for publication, demonstrated that a single strategy was unlikely to be effective, confirming results presented in the article "Effectiveness of a call/recall system in improving compliance with cervical cancer screening: a randomized controlled trial" (CMAJ 1997;157[5]:521-6 [full text / résumé]), by Drs. Sharon K. Buehler and Wanda L. Parsons. A combination of strategies and approaches is more likely to be effective,2 although it is also expensive.3 Because of the cost, it is vital that we in Canada take advantage of the networking opportunity offered at the national level through the CCPN and establish similar collaborative efforts at the provincial level, such as the Ontario Cervical Screening Collaborative Group.4 The Recruitment Working Group has encouraged submissions of proposals to the Federal Population Health Fund focusing on recruitment of 3 hard-to-reach groups: socially and economically disadvantaged women, immigrants and native women.

The statement in Grunfeld's editorial attributed to Hislop and associates5 -- that the rate among native women is 6 times that of the general population -- is misleading. The "general population" in the cited article is that of British Columbia, which has the lowest rates of cervical cancer in Canada. According to a recent study, the incidence of cervical cancer among status Indians in Ontario was slightly less than twice that of the general population of Ontario, and between 1968 and 1991 the rates in both groups declined (Dr. L.D. Marrett, Cancer Care Ontario, Toronto: personal communication, 1997).

As the editorial stresses, cost-effective interventions are the order of the day. Those of us working to develop cervical screening programs know that if the incidence of cervical cancer is reduced, the savings in treatment and long-term care will quickly result in a net cost savings to the health care system, quite apart from preventing unnecessary suffering for hundreds of women and their families.

E. Aileen Clarke, MB, MSc
Chair
Recruitment Working Group
Cervical Cancer Prevention Network
Toronto, Ont.

References

  1. Parboosingh EJ, Anderson G, Clarke EA, Inhaber S, Kaegi E, Mills C, et al. Cervical cancer screening: Are the 1989 recommendations still valid? CMAJ 1996;154(12);1847-53.
  2. Anti-Cancer Council of Victoria, Victorian Cervical Cytology Registry. Pap test Victoria 1991-1994. Final report, 1995. Victoria, Australia: The Council; 1995.
  3. Anti-Cancer Council of Victoria. PapScreen Victoria recruitment strategy 1996-99. Victoria, Australia: The Council; 1996.
  4. Clarke EA. Cervical screening in Ontario: collaborative group seeks to reduce incidence and mortality rates of cervical cancer. Ont Med Rev 1996;40-1.
  5. Hislop TG, Clarke HF, Deschamps M, Joseph R, Band PR, Smith J, et al. Cervical cytology screening: How can we improve rates among First Nations women in urban British Columbia? Can Fam Physician 1996;42:1701-8.

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| CMAJ February 10, 1998 (vol 158, no 3) / JAMC le 10 février 1998 (vol 158, no 3) |