Cervical cancer screening detects pre-cancerous changes in the cervix, such as cervical intraepithelial neoplasia (CIN) or cervical dysplasia. Introduction of the Papanicolau (Pap) test screening programs to women in all populations reduces cervical cancer rates by 60–90 percent within 3 years of implementation, with the reduction of mortality and morbidity consistent across populations [1, 2]. In the US, the US Preventative Task Force guidelines for Pap testing are every 3 years for routine screening by women over the age of 21, or from three years after the age of initiation of sexual activity, whichever is earlier .
Hispanic women in the US have the highest cervical cancer incidence with an age-adjusted incidence of 12.5 cases/100,000 women for 2004–2008, compared to an incidence of 7.0 in the non-Hispanic white population . Mortality from cervical cancer is also higher among Hispanics compared to non-Hispanic whites (estimates for age-adjusted U.S. mortality rates for 2008: 2.9 per 100,000 vs. 2.1 per 100,000) . The disproportionate burden of cervical cancer among Hispanic women is thought to be attributable in part to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. Data from the National Health Interview Survey show that 74.6% of Hispanic women had a Pap test in the past three years compared to 81.4% of non-Hispanic whites . Similarly, Hispanic non-adherence with recommended follow-up has been reported in several regional studies to range from 20 to 90% [6, 7].
Sociodemographic factors associated with non-adherence to cervical cancer screening in this population include low income, lack of health insurance, limited access to healthcare services, lack of clinician recommendation, length of residency in the United States, limited English language proficiency, acculturation, and lack of awareness of risks associated with non-participation in cervical cancer screening programs [8–11].
The aims of the Cervical Cancer Screening and Adherence to Follow-up Among Hispanic Women study are threefold: (1) to determine the effect of two different intensity, culturally appropriate information based interventions on Pap test utilization, vs. control; (2) to determine whether a patient navigator program can improve adherence to follow-up after a diagnosis of an abnormal Pap test, in a sample of Hispanic women in Yakima and Franklin counties of Washington (WA) State, US; and (3) to assess the cost-effectiveness of each of the intervention programs.
The study will be implemented with the aid of the two community based partners, the Yakima Valley Farm Workers’ Clinic (YVFWC) which operates a network of 13 federally qualified health center clinics in Eastern Washington specializing in the delivery of primary care services to low-income Latinos; and the Breast, Cervical, and Colon Health Program of the Yakima District (BCCHP), a federally funded aid program, administered through the Washington State Department of Health, which provides assistance and resources for women to undergo Pap tests, and for women who receive a diagnosis of an abnormal Pap test.
BCCHP and YVFWC will work with the study investigators to identify women who are non-compliant with Pap testing to monitor uptake of Pap test screening among randomized women via medical record review, and to develop and pilot test a patient navigator program to improve adherence and reduce time to follow-up after an abnormal Pap test.
To aid with issues regarding cultural relevance, a community advisory board was appointed and regular meetings are scheduled between the investigators and community members.