Characteristics of respondents to a cervical cancer screening program in a developing country.

BACKGROUND: Characteristics associated with the response to a personalized, mailed invitation for the Papanicolaou (Pap) test vary among women. This study assesses the relationship between selected characteristics (e.g., demographic, obstetric, Pap history) and the response to a letter of invitation to undergo a Pap test among Mexican women affiliated with the Mexican Social Security Institute (IMSS). METHODS: Study subjects were 328 women affiliated with the IMSS who received and responded to a mailed letter of invitation, and 247 age- and clinically matched controls who received but did not respond to the letter of invitation. Statistical analysis consisted of multivariate conditional regression model. RESULTS: Having better housing conditions was one of the factors associated with letter response (medium level vs. low level, odds ratio [OR] = 3.17, 95% confidence interval [95% CI] = 2.46-4.09; high level vs. low level, OR = 2.65, 95% CI = 2.06-3.41). Other factors positively associated with letter response were greater number of pregnancies, previous Pap testing, being pleased at receipt of the letter of invitation, and knowing another woman who had received the invitation. Factors associated negatively to letter response were 7 or more years of formal education (> or =7 years vs. 0-6 years, OR = 0.50, 95% CI = 0.40-0.63), having a current job, availability of other medical services in addition to the IMSS, and willingness to receive Pap results by mail. CONCLUSIONS: Low educational level is not a limitation for cervical cancer screening call and recall among women affiliated with the IMSS.

Proposal to institutionalize criteria and quality standards for cervical cancer screening within a health care system

O colo uterino é a localizaçäo tumoral mais importante em mulheres na América Latina, ocorrendo aproxiamadamente 52 mil novos casos anualmente na regiäo. Assim, a necessidade de melhorar a eficiência e efetividade dos programas de rastreamento de câncer de colo uterino (PRCC) é fundamental para que ocorra o decréscimo do sofrimento desnecessário experimentado por essas mulheres. Aborda questöes essenciais para revitalizar o PRCC, tal como proposto pela regulamentaçäo oficial no México. Um marco teórico para institucionalizaçäo do PRCC é delineado, seguindo-se a apresentaçäo de estratégias, visando fortalecer seu desempenho por meio de medidas organizacionais capazes de assegurar a qualidade da assistência prestada. Focaliza as atividades seguintes: 1) melhora da cobertura; 2) implementaçäo no controle de qualidade da obtençäo de amostras para exame; 3) melhoria na qualidade de interpretaçäo do exame de Papanicolau; 4) garantia de tratamento na presença de anomalias detectadas; 5) melhoria do seguimento; 6) desenvolvimento de medidas de controle da qualidade e 7) desenvolvimento de sistemas de monitoramento e de informaçäo em vigilância epidemiológica.