https://orcid.org/0000-0002-3242-0486
Abstract
Background
Many countries organize population-based cervical cancer screening programs (CSP). In the Netherlands, eligible women are invited by mail. Marginalized women living in unstable conditions and homeless women often fail to receive the invitation letter. These women also experience access barriers to regular healthcare. Consequently, despite presumably being at higher risk of developing cervical cancer due to prevalent risk factors, marginalized women are rarely screened for cervical cancer. The aim of the study was to identify the prevalence of (pre)cancerous abnormalities among marginalized women, and subsequently explore invitation approaches to enhance their screening participation.
Methods
A cross-sectional intervention study was conducted in Rotterdam, the Netherlands. Between February and May 2019, marginalized women aged 20–60 years were invited to participate in cervical screening. A participant was considered screen-positive when they tested positive for high-risk human papilloma virus (HR-HPV) and showed cytological abnormalities. Data of the study population were compared with regional data of the Dutch CSP. Various invitation approaches were used to recruit women.
Results
Out of 74 included women, 12 participants (16%) were found screen-positive, against 3.4% in women screened by the Dutch CSP. The prevalence ratio for the study population was 4.4 (95% CI 1.9–8.6) compared with women screened by the Dutch CSP. Using a direct, pro-active approach resulted in participation of 92% of the included women.
Conclusion
Marginalized women have an increased risk of (pre)cancerous cervical abnormalities in screening, compared with women screened by the Dutch CSP. A direct pro-active approach was the most effective to stimulate screening participation. Enhancement of screening uptake for this population needs special effort.
Acknowledgments
The authors wish to thank all partners who welcomed the medical team with trust and expertise on how to engage the study population. Many acknowledgements to Annelies van Vliet-Klerk from the Erasmus Medical Center for coordinating the liquid-based cytology sampling, and to all members of the cytology team for analyzing the cervical samples. Appreciation for Stichting Bevolkingsonderzoek Zuid-West for covering a part of the costs and by supporting this research. Gratitude to the Netherlands Streetdoctors Group for solving the financial puzzle, regarding the cytology sampling.
Disclosure
The authors report no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors received non-financial support from the Netherlands Streetdoctors Group, non-financial support from Erasmus Medical Center, and non-financial support from Stichting Bevolkingsonderzoek Zuid-West.