Adherence to cervical and breast cancer programs is crucial to improving screening performance.
BACKGROUND
Cervical and breast cancer are the most common malignancies among women worldwide. Effective screening can facilitate early detection and dramatically reduce mortality rates. The interface between those screening patients and patients most needing screening is complex, and women in remote areas of rural counties face additional barriers that limit the effectiveness of cancer prevention programs. This study compared various methods to improve compliance with mass screening for breast and cervical cancer among women in a remote, rural region of Brazil.


METHODS
In 2003, a mobile unit was used to perform 10,156 mammograms and Papanicolaou smear tests for women living in the Barretos County region of São Paulo state, Brazil (consisting of 19 neighbouring cities). To reach the women, the following community outreach strategies were used: distribution of flyers and pamphlets; media broadcasts (via radio and car loudspeakers); and community healthcare agents (CHCAs) making home visits.


RESULTS
The most useful intervention appeared to be the home visits by healthcare agents or CHCAs. These agents of the Family Health Programme of the Brazilian Ministry of Health reached an average of 45.6% of those screened, with radio advertisements reaching a further 11.9%. The great majority of the screened women were illiterate or had elementary level schooling (80.9%) and were of 'poor' or 'very poor' socioeconomic class (67.2%).


CONCLUSIONS
Use of a mobile screening unit is a useful strategy in developing countries where local health systems have inadequate facilities for cancer screening in underserved populations. A multimodal approach to community outreach strategies, especially using CHCAs and radio advertisements, can improve the uptake of mass screening in low-income, low-educational background female populations.
Barretos Cancer Hospital - Department of Cancer Screening, São Paulo, Brazil. prevencao@hcancerbarretos.com.br.
Edmundo C
EC
Mauad
Sérgio M
SM
Nicolau
Luiz F
LF
Moreira
Raphael L
RL
Haikel
Adhemar
A
Longatto-Filho
Edmund C
EC
Baracat
D000328:Adult; D000368:Aged; D001938:Brazil; D001943:Breast Neoplasms / Q000517:prevention & control*; D003159:Community-Institutional Relations; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography; D008402:Mass Media; D008403:Mass Screening; D008875:Middle Aged; D008952:Mobile Health Units; D065006:Papanicolaou Test; D010349:Patient Compliance; D012424:Rural Population; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears; D055815:Young Adult