Vogt Thomas M, Glass Andrew, Glasgow Russell E, La Chance Pierre A, Lichtenstein Edward
Kaiser Permanente Center for Health Research Hawaii, Honolulu, Hawaii 96817, USA.
J Womens Health (Larchmt). 2003 Oct;12(8):789-98. doi: 10.1089/154099903322447756.
The purposes of the study were (1). to assess the cost-effectiveness of three interventions to deliver breast and cervical cancer screening to women unscreened for >or=3 years and (2). to determine the relation of an invasive cervical cancer diagnosis to the interval since the last true screening test.
In a randomized trial, women were randomly assigned to (1). usual care, (2). letter plus follow-up letter, (3). letter plus follow-up phone call, (4). phone call plus follow-up phone call. Screening within 12 weeks was the outcome. A 5-year retrospective review of cervical cancer cases and screening histories was done.
The 8% of women not screened for >or=5 years had 62% of the invasive cervical cancer cases. Mammography outreach led to screening in 10%, 24%, 51%, and 50% of controls, letter/letter, letter/phone, and phone/phone interventions groups, respectively. Cervical cancer screening outreach led to screening in 17%, 22%, 54%, and 50% of the respective groups. Letter reminders alone produced fewer tests at substantially higher costs than did personalized telephone notification.
For cervical cancer, only 1 person in 12 was not screened in the preceding 5 years, but these accounted for nearly two thirds of invasive cancers. Aggressive outreach to the rarely screened is an important part of screening programs. Letter reminder, followed by a telephone appointment call, was the most cost-effective approach to screening rarely screened women. Lack of accurate information on prior hysterectomy adds substantial unnecessary costs to a screening reminder program.
本研究的目的是：（1）评估三种干预措施对未接受筛查达3年及以上的女性进行乳腺癌和宫颈癌筛查的成本效益；（2）确定浸润性宫颈癌诊断与上次真正筛查测试后的时间间隔之间的关系。
在一项随机试验中，女性被随机分配至：（1）常规护理组；（2）信件加随访信件组；（3）信件加随访电话组；（4）电话加随访电话组。以12周内的筛查情况作为结果。对宫颈癌病例和筛查史进行了为期5年的回顾性研究。
未接受筛查达5年及以上的女性占8%，但浸润性宫颈癌病例中有62%出自该群体。乳腺钼靶筛查推广使对照组、信件/信件干预组、信件/电话干预组和电话/电话干预组的筛查率分别达到10%、24%、51%和50%。宫颈癌筛查推广使相应组别的筛查率分别达到17%、22%、54%和50%。仅信件提醒产生的检查较少，且成本远高于个性化电话通知。
对于宫颈癌，在过去5年中，每12人中只有1人未接受筛查，但这些人占浸润性癌症的近三分之二。对极少接受筛查者进行积极推广是筛查计划的重要组成部分。信件提醒，随后进行电话预约，是对极少接受筛查的女性进行筛查的最具成本效益的方法。缺乏关于既往子宫切除术的准确信息会给筛查提醒计划增加大量不必要的成本。
