Organised Versus Opportunistic Cervical Cancer Screening in Urban and Rural Regions of Lithuania

Abstract

Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme’s coverage is insufficient. The aim of this study was to assess the effect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25–60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor’s appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more effective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.

Determinants of Population-Based Cancer Screening Performance at Primary Healthcare Institutions in China

“…Furthermore, research and practice have shown that cervical cancer screening rate is highly correlated with mammography screening rate [ 35 ]. Our finding is consistent with that of Yang et al, Huang et al, and Paulauskiene et al who found that the coverage and participation of breast and cervical cancer screening were higher in rural regions compared to urban regions in China and Lithuania [ 38 , 39 , 40 ]. In addition, institutions in lower GDP districts showed a better screening performance than those in higher GDP districts.…”

“…These findings suggest that more people should be encouraged to work in the primary healthcare system, and that the training for cancer screening should be strengthened, to augment the quantity and quality of staff dedicated to cancer screenings [ 34 , 41 ]. In addition, to improve population-based cancer screening performance appropriate screening techniques should be made available, more medical resources should be introduced, and program supervision should be strengthened [ 29 , 30 , 38 ]. Finally, to identify target population who are less likely to be exposed to cancer screenings is critical to screening participation and performance.…”

Students’ Knowledge about Cervical Cancer Prevention in Poland

“…A systematic personal invitation for cervical cancer screening seems to be an effective form of information about screening. The one reminder letter used in Lithuania more than doubled the coverage of screening [ 62 ].…”

Comparisons of Papanicolaou Utilization and Cervical Cancer Detection between Rural and Urban Women in Taiwan

“…An earlier Lithuanian survey found that the amount of women who had participated in the Nationwide Cervical Cancer Screening Program was lower in urban areas than in rural areas (9.6 vs. 14.7%) [ 31 ]; however, a reminder letter increased attendance to 24.6% and 30.8%, respectively. In the UK, the 5-year coverage of the Pap test rate in women ranged between 77.8%–79.0% in 2011–2012 [ 32 ].…”