title: Analysis of three strategies to increase screening coverage for cervical cancer in the general population of women aged 60 to 70 years: the CRICERVA study.
abstract: BACKGROUND
  Cervical cancer is a frequently diagnosed cancer in women worldwide. Despite having easy preventive and therapeutic approaches, it is an important cause of mortality among women.
  
  
  METHODS
  The CRICERVA study is a cluster clinical trial which assigned one of three interventions to the target population registered in Cerdanyola, Barcelona. Among the 5,707 resident women aged 60 to 70 years in the study area, women with no record of cervical cytology over the last three years were selected. The study included four arms: three interventions all including a pre-assigned date for screening visit and i) personalized invitation letter; ii) adding to i) an informative leaflet; and, iii) in addition to ii) a personalized appointment reminder phone call, and iv) no specific action taken (control group). Participants were offered a personal interview about social-demographic characteristics and about screening attitudes. Cervical cytology and HPV DNA test (HC2) were offered as screening tests. In the case of screening positive in any of these tests, the women were followed up until a full diagnosis could be obtained. The effect size of each study arm was estimated as the absolute gain in coverage between the original coverage and the final coverage.
  
  
  RESULTS
  From the intervention groups (4,775 women), we identified 3,616 who were not appropriately screened, of which 2,560 women answered the trial call and 1,376 were amenable to screening. HPV was tested in 920 women and cervical cytology in all 1,376. Overall, there was an absolute gain in coverage of 28.8% in the intervention groups compared to 6% in the control group. Coverage increased from 51.2% to 76.0% in strategy i); from 47.4% to 79.0% in strategy ii) and from 44.5% to 74.6% in strategy iii). Lack of information about the relevance of screening was the most important factor for not attending the screening program.
  
  
  CONCLUSIONS
  The study confirms that actively contacting women and including a date for a screening visit, notably increased participation in the screening program. Efforts to improve health education in preventative activities are warranted.
  
  
  BACKGROUND
  Clinical Trials.gov Identifier NCT01373723. Registered 14 June 2011.
authors.affiliation: Atenció a la Salut Sexual i Reproductiva (ASSIR), SAP Cerdanyola -Ripollet, Institut Català de la Salut, Carretera N-150 s/n, Ripollet, Barcelona, Spain. amelia.acera@gmail.com.
authors.forename: Amelia
authors.initials: A
authors.lastname: Acera
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Manresa
authors.forename: Diego
authors.initials: D
authors.lastname: Rodriguez
authors.forename: Ana
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Bonet
authors.forename: Norman
authors.initials: N
authors.lastname: Sanchez
authors.forename: Pablo
authors.initials: P
authors.lastname: Hidalgo
authors.forename: Pilar
authors.initials: P
authors.lastname: Soteras
authors.forename: Pere
authors.initials: P
authors.lastname: Toran
authors.forename: Marta
authors.initials: M
authors.lastname: Trapero-Bertran
authors.forename: Iris
authors.initials: I
authors.lastname: Lozano
authors.forename: Silvia
authors.initials: S
authors.lastname: De Sanjose
mesh_terms: D000368:Aged; D065309:Atypical Squamous Cells of the Cervix; D002277:Carcinoma / Q000175:diagnosis*; D015709:Correspondence as Topic; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D018579:Patient Selection; D013030:Spain; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*