Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial

Background: Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. Metho...

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Autores: Acera Pérez, Amèlia, Manresa Domínguez, Josep Maria, Rodriguez, Diego, Rodriguez, Ana, Bonet, Josep Maria, Trapero Bertran, Marta, Hidalgo Valls, Pablo, Sanchez Sanchez, Norman, Sanjosé Llongueras, Silvia de
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/125252
Acceso en línea:https://hdl.handle.net/2445/125252
Access Level:acceso abierto
Palabra clave:Càncer de coll uterí
Citologia
Cervix cancer
Cytology
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spelling Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical TrialAcera Pérez, AmèliaManresa Domínguez, Josep MariaRodriguez, DiegoRodriguez, AnaBonet, Josep MariaTrapero Bertran, MartaHidalgo Valls, PabloSanchez Sanchez, NormanSanjosé Llongueras, Silvia deCàncer de coll uteríCitologiaCervix cancerCytologyBackground: Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. Methods: The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona. A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a "rescue" visit as the screening visit resulting from the study invitation. Results: Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p< 0.001). However, the differences were more substantial in the age groups 50-59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women. Conclusions: The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age.Public Library of Science (PLoS)2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/125252Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1371/journal.pone.0170371PLoS One, 2017, vol. 12, num. 1, p. e0170371https://doi.org/10.1371/journal.pone.0170371cc by (c) Acera et al., 2017http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1252522026-05-27T06:46:51Z
dc.title.none.fl_str_mv Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
title Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
spellingShingle Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
Acera Pérez, Amèlia
Càncer de coll uterí
Citologia
Cervix cancer
Cytology
title_short Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
title_full Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
title_fullStr Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
title_full_unstemmed Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
title_sort Increasing Cervical Cancer Screening Coverage: A Randomised, Community-based Clinical Trial
dc.creator.none.fl_str_mv Acera Pérez, Amèlia
Manresa Domínguez, Josep Maria
Rodriguez, Diego
Rodriguez, Ana
Bonet, Josep Maria
Trapero Bertran, Marta
Hidalgo Valls, Pablo
Sanchez Sanchez, Norman
Sanjosé Llongueras, Silvia de
author Acera Pérez, Amèlia
author_facet Acera Pérez, Amèlia
Manresa Domínguez, Josep Maria
Rodriguez, Diego
Rodriguez, Ana
Bonet, Josep Maria
Trapero Bertran, Marta
Hidalgo Valls, Pablo
Sanchez Sanchez, Norman
Sanjosé Llongueras, Silvia de
author_role author
author2 Manresa Domínguez, Josep Maria
Rodriguez, Diego
Rodriguez, Ana
Bonet, Josep Maria
Trapero Bertran, Marta
Hidalgo Valls, Pablo
Sanchez Sanchez, Norman
Sanjosé Llongueras, Silvia de
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Càncer de coll uterí
Citologia
Cervix cancer
Cytology
topic Càncer de coll uterí
Citologia
Cervix cancer
Cytology
description Background: Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. Methods: The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona. A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a "rescue" visit as the screening visit resulting from the study invitation. Results: Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p< 0.001). However, the differences were more substantial in the age groups 50-59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women. Conclusions: The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age.
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/125252
url https://hdl.handle.net/2445/125252
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1371/journal.pone.0170371
PLoS One, 2017, vol. 12, num. 1, p. e0170371
https://doi.org/10.1371/journal.pone.0170371
dc.rights.none.fl_str_mv cc by (c) Acera et al., 2017
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Acera et al., 2017
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Public Library of Science (PLoS)
publisher.none.fl_str_mv Public Library of Science (PLoS)
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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