Increasing Breast and Cervical Cancer Screening in Low-Income Women

Authors


Dr. Margolis: Berman Center for Outcomes and Clinical Research (865B), Hennepin County Medical Center, 701 Park Ave., Suite 824, Minneapolis, MN 55404.

Abstract

OBJECTIVE:

To determine if women would have higher breast and cervical cancer screening rates if lay health advisers recommended screening and offered a convenient screening opportunity.

DESIGN:

Controlled trial.

SETTING:

Urban county teaching hospital.

PARTICIPANTS:

Women aged 40 years and over attending appointments in several non-primary-care outpatient clinics.

INTERVENTIONS:

Lay health advisers assessed the participants’ breast and cervical cancer screening status and offered women in the intervention group who were due for screening an appointment with a female nurse practitioner.

MEASUREMENTS AND MAIN RESULTS:

Screening rates at baseline and at follow-up 1 year after the intervention were determined. At follow-up, the mammography rate was 69% in the intervention group versus 63% in the usual care group (p = .009), and the Pap smear rate was 70% in the intervention group versus 63% in the usual care group (p = .02). In women who were due for screening at baseline, the mammography rate was 60% in the intervention group versus 50% in the usual care group (p = .006), and the Pap smear rate was 63% in the intervention group versus 50% in the usual care group (p = .002). The intervention was effective across age and insurance payer strata, and was particularly effective in Native American women.

CONCLUSIONS:

Breast and cervical cancer screening rates were improved in women attending non-primary-care outpatient clinics by using lay health advisers and a nurse practitioner to perform screening. The effect was strongest in women in greatest need of screening.

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