title: Effectiveness of letters to Cape Breton women who have not had a recent Pap smear.
abstract: Nova Scotia, and especially Cape Breton, has high cervical cancer incidence and mortality rates. Letters were sent to 15,691 unscreened and 6,995 under-screened women from Cape Breton Island encouraging them to obtain a Pap test. Controls were 61,510 unscreened women and 32,996 under- screened women in mainland Nova Scotia who were not sent letters. For this cohort study, the provincial Health Card Number database and Provincial Cytology Registry were linked. Having a Pap smear was associated with having received a letter (OR = 1.64), having been previously under-screened rather than unscreened (OR = 1.85), with youth and with higher income (OR = 1.13). After receiving a letter, women in Aboriginal, Mixed Black, Acadian, and rural communities had smear rates similar to those of other women. Being previously unscreened, rather than under-screened, was associated with higher rates of abnormalities (OR = 1.62), indicating greater need for early detection and treatment to prevent invasive cancer. While one-time letters to women improved the Pap smear screening rates, multiple, continuous interventions are needed to make a more substantive improvement in these rates.
authors.affiliation: School of Health Services Administration, Dalhousie University and Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, Halifax, Canada. Grace.Johnston@cdha.nshealth.ca
authors.forename: G M
authors.initials: GM
authors.lastname: Johnston
authors.forename: C J
authors.initials: CJ
authors.lastname: Boyd
authors.forename: M A
authors.initials: MA
authors.lastname: MacIsaac
authors.forename: J W
authors.initials: JW
authors.lastname: Rhodes
authors.forename: R N
authors.initials: RN
authors.lastname: Grimshaw
mesh_terms: D000328:Adult; D000368:Aged; D015709:Correspondence as Topic; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012042:Registries; D017010:Reminder Systems; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health