Can older women be motivated to attend for their final Papanicolaou tests? The use of targeted and general personalised reminder letters.
BACKGROUND
Australian guidelines allow women to cease having Papanicolaou (Pap) tests at the age of 70, providing they have had two negative smears in the previous 5 years. In Victoria, a standard reminder letter system is in place and women receive one reminder letter 27 months after their last Pap test.


METHODS
A targeted letter informed by qualitative research was developed to specifically encourage older women to have a final Pap test. The Victorian Cervical Cytology Registry (VCCR) was used to identify 15,000 women aged 65-69 who had not had a Pap test for at least 3 years and up to 17 years. Women were randomly allocated to receive either no letter (control group), the targeted letter or a personally addressed general reminder letter.


RESULTS
At 11 weeks follow-up, 4.3% of women (CI 3.7-4.8%) who received the targeted letter had attended for a Pap test compared with 4.7% (CI 4.1-5.3%) of those receiving the general letter and 1.6% (CI 1.2-1.9%) of the control group. Effectiveness was limited to women whose test was no more than 10 years overdue, and was particularly strong for those whose test was 3-5 years overdue.


CONCLUSIONS
This suggests that a reminder letter was effective, but that targeting the information in the letter did not further improve screening attendance. A second reminder letter sent to women before their Pap test is more than 5 years overdue has potential for increasing the number of women attending for screening.
Mullins
Robyn M
RM
Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Carlton South, Victoria 3053, Australia. Robyn.Mullins@cancervic.org.au
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data*