Piana Lucien, Leandri François-Xavier, Jacqueme Béatrice, Heid Patrice, Corti Jean, Andrac-Meyer Lucile, Sancho-Garnier Hélène
Arcades (Association pour la recherche et le dépistage des cancers du sein, du col de l'utérus et des cancers colorectaux), Hôpital de la Timone, rue Saint-Pierre, Bât F, 13005 Marseille.
Bull Cancer. 2007 May;94(5):461-7.
Individual cervical screening with pap-smears is the major cause of the decrease in incidence and mortality of cervical cancer in France since more than 30 years. But, for the last ten years, the decrease in mortality is limited due to the persistence of poor prognostic cases and the insufficiency of treatment efficacy in such patients. These cases are mostly observed in women who did not participate to regular screening. They are generally from low socioeconomic levels or migrant populations, or both. Such an observation leads us to organize 3 successive pilot campaigns (2001, 2003, 2005) in the Northern part of Marseille city where the rate of such poor population is high (37 to 45%). The women without a pap-smear indexed in the National Insurance Register for the last 3-2 years were invited by individual mailing to perform, free of charge, a pap-smear. The evaluation of each campaign helps us to improve the next one. The major changes from the 1st one to the 3rd one were to increase the number of free screening services, to send a second invitation to the non responders, and to organize local meetings with social workers and nurses to explain to the women the importance of performing regular screening tests. The final results after the 3 campaigns showed : out of the eligible women the participation rates are dramatically low evolving from 1,56 % to 2,48% and 6,87% of pap-smears done along the 3 campaigns ; the selection of women "without pap-smear" from the national Insurance register was not good, a great number of missing data was identified, explaining partly the extremely low rate of participation ; the factors increasing a little the participation are the second mailing of invitation (39 % of pap-smears realised) ; the total gratuitous of the screening (both sampling and reading) ; the oral information delivered locally by social workers and the proximity of the places to perform the test ; the quality of the pap-smears collected by gynecologists was good but insufficient for other health professionals, requiring a specific training for cervical cell collection. The organization of such pilot projects need to be followed to find better solutions to increase the participation to cervical screening of such populations who are at high risk of poor prognosis cervical cancers.
30多年来，法国通过单独的巴氏涂片进行宫颈癌筛查是宫颈癌发病率和死亡率下降的主要原因。但是，在过去十年中，由于预后不良病例持续存在以及此类患者治疗效果不佳，死亡率下降有限。这些病例大多出现在未参加定期筛查的女性中。她们通常来自社会经济水平较低的群体或移民人口，或两者皆是。这样的观察结果促使我们在马赛市北部连续组织了3次试点活动（2001年、2003年、2005年），那里此类贫困人口比例很高（37%至45%）。过去3至2年在国家保险登记册中没有巴氏涂片记录的女性通过个人邮件被邀请免费进行巴氏涂片检查。每次活动的评估有助于我们改进下一次活动。从第一次到第三次活动的主要变化是增加免费筛查服务的数量，向未回应者发送第二次邀请，并与社会工作者和护士组织当地会议，向女性解释进行定期筛查测试的重要性。3次活动后的最终结果显示：在符合条件的女性中，参与率极低，3次活动中进行巴氏涂片检查的比例从1.56%升至2.48%和6.87%；从国家保险登记册中挑选“无巴氏涂片记录”的女性情况不佳，发现大量缺失数据，这部分解释了极低的参与率；稍微提高参与率的因素是第二次邮寄邀请（完成巴氏涂片检查的比例为39%）；筛查完全免费（采样和解读）；社会工作者在当地提供的口头信息以及检查地点的便利性；妇科医生采集的巴氏涂片质量良好，但对其他卫生专业人员来说不够，需要针对宫颈细胞采集进行专门培训。需要继续开展此类试点项目，以找到更好的解决方案，提高这类宫颈癌预后不良高风险人群参与宫颈癌筛查的比例。
