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Cancer Control Research

Abstract

Low-income women are at high risk for developing cervical cancer due not only to the higher prevalence of risk factors and lack of access to screening, but also because of barriers to timely follow-up when screened and found to have an abnormality. Lack of follow-up, therefore, contributes to the racial and ethnic health outcome disparities that exist for cervical cancer. While other interventions have shown some success at improving Pap smear follow-up rates, there is no existing randomized intervention trial that has demonstrated such high rates of improvement in follow-up as the Pathfinders study that addresses follow-up barriers in a very high-risk population of ethnically diverse, low-income, inner city women. The intervention consisted of computer-assisted tracking, education, counseling in consumer skills and ways of coping, transportation vouchers, and referrals for suspected mental health, alcohol/drug abuse, and domestic violence. When analyzed by intention to treat, of 348 women who were randomized at the time of the institutional receipt of the abnormal result, twice as many women in the intervention group were confirmed to have a follow-up test within 6 mos. of their abnormal Pap smear than in the control group, 70% versus 36% (p<0.01). By using an expanded tracking protocol, we were able to locate and to deliver the intervention to 128/178 women in the intervention group. Of those who received the intervention, 83% had a documented follow-up test with 6 mos. versus 36% in the intervention group who did not receive the intervention (p<0.01). Overall, we were unable to contact 18 (10%) women, 16 (9%) moved, and 11 (6%) refused the counseling intervention. The average time-cost of tracking and outreach counseling per woman was 109 min. With this project, we have demonstrated that low follow-up rates can be substantially improved by the implementation of a more personal and culturally tailored approach, coupled with utilization of state-of-the-art computer assistance. This supplement addresses the need for dissemination of cost-effective interventions that improve Pap smear follow-up in high-risk populations. We propose a strategy for dissemination and maintenance of the intervention on a local-scale. If successful, we will adapt the intervention, based on what we have learned, for more widespread dissemination.