Comparative community outreach to increase cervical cancer screening in the Mississippi Delta

Abstract

Objective: The aim of the study was to increase participation in cervical cancer screening of under-screened women living in the Mississippi Delta, a U.S. population at high risk for cervical cancer.

Methods: We conducted a door-to-door feasibility study of women living in the Mississippi Delta to increase participation in cervical cancer screening in 2009-10. Women (n=119) aged 26-65 years who had not been screened in last 3 years or more, were not pregnant, and had a cervix were offered a cost-free choice: clinic-based Pap testing or home self-collection with HPV DNA testing.

Results: Seventy-seven women (64.7%) chose self-collection with HPV testing, of which sixty-two (80.5%) returned their self-collected specimen. By comparison, 42 women (35.3%) chose Pap testing, of which 17 (40.5%) attended their clinic appointment. Thus there was an almost 4-fold greater participation of under-screened women in self-collection with HPV testing than in free Pap testing (78.4% vs. 21.5%).

Conclusions: We found that offering self-collection will increase participation in cervical cancer screening among under-screened populations living in the Mississippi Delta. Based on these preliminary results, we suggest that self-collection with HPV DNA testing might complement current Pap testing programs to reach under-screened populations of women, such as those living in the Mississippi Delta.

Published by Elsevier Inc.

Figures

Figure 1. County-Specific Age-Standardized Cervical Cancer Rates in MS and AL

County-level mortality (per 100,000) due to cervical cancer in Mississippi (USA)(Freeman and Wingrove 2007) (courtesy of the National Cancer Institute, NIH). The green arrow indicates where the study was conducted in 2009-10.

Figure 2. Consort Diagram for Participation

The flowchart shows the outcomes of the study conducted in 2009-10 to increase cervical cancer screening participation in Sunflower County, Mississippi. Definitions are as follows: ineligible households had no women in the correct age range; unavailable households were those that we did not get a response; ineligible women = did not meet inclusion criteria (see text); unavailable women = women in eligible households who we could not assess for eligibility in the study (e.g., working, too busy, etc.).