Increasing breast and cervical cancer screening in low-income women

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Abstract
OBJECTIVE: To determine if women would have higher breast and cervical cancer screening rates if lay health advisers recommended screening and offered a convenient screening opportunity. DESIGN: Controlled trial. SETTING: Urban county teaching hospital. PARTICIPANTS: Women aged 40 years and over attending appointements in several non-primary-care outpatient clinics. INTERVENTIONS: Lay health advisers assessed the participants’ breast and cervical cancer screening status and offered women in the intervention group who were due for screening an appointment with a female nurse practitioner. MEASUREMENTS AND MAIN RESULTS: Screening rates at base-line and at follow-up 1 year after the intervention were determined. At follow-up, the mammography rate was 69% in the intervention group versus 63% in the usual care group (p=.009), and the Pap smear rate was 70% in the intervention group versus 63% in the usual care group (p=.02). In women who were due for screening at baseline, the mammography rate was 60% in the intervention group versus 50% in the usual care group (p=.006), and the Pap smear rate was 63% in the intervention group versus 50% in the usual care group (p=.002). The intervention was effective across age and insurance payer strata, and was particularly effective in Native American women. CONCLUSIONS: Breast and cervical cancer screening rates were improved in women attending non-primary-care outpatient clinics by using lay health advisers and a nurse practitioner to perform screening. The effect was strongest in women in greatest need of screening.

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