Bongaerts Thomas H G, Ridder Marlieke, Vermeer-Mens Josephina C J, Plukkel Jeanette J, Numans Mattijs E, Büchner Frederike L
Leiden University Medical Center LUMC-Campus the Hague, Department of Public Health and Primary Care, The Hague, the Netherlands.
Municipal Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands.
Int J Womens Health. 2021 Jun 8;13:549-556. doi: 10.2147/IJWH.S302002. eCollection 2021.
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.
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.
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.
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.
许多国家都组织了基于人群的宫颈癌筛查项目（CSP）。在荷兰，符合条件的女性会收到邮寄邀请。生活条件不稳定的边缘化女性和无家可归的女性往往无法收到邀请信。这些女性在获得常规医疗保健方面也面临障碍。因此，尽管由于普遍存在的风险因素，边缘化女性患宫颈癌的风险可能更高，但她们很少接受宫颈癌筛查。本研究的目的是确定边缘化女性中癌前异常的患病率，随后探索提高她们筛查参与率的邀请方法。
在荷兰鹿特丹进行了一项横断面干预研究。2019年2月至5月期间，邀请20至60岁的边缘化女性参加宫颈癌筛查。当参与者高危人乳头瘤病毒（HR-HPV）检测呈阳性且显示细胞学异常时，被视为筛查阳性。将研究人群的数据与荷兰CSP的区域数据进行比较。采用了各种邀请方法来招募女性。
在纳入的74名女性中，有12名参与者（16%）筛查呈阳性，而荷兰CSP筛查的女性中这一比例为3.4%。与荷兰CSP筛查的女性相比，研究人群的患病率比为4.4（95%CI 1.9-8.6）。采用直接、积极主动的方法，92%的纳入女性参与了筛查。
与荷兰CSP筛查的女性相比，边缘化女性在筛查中出现宫颈癌前异常的风险增加。直接积极主动的方法是刺激筛查参与最有效的方法。提高这一人群的筛查接受率需要做出特别努力。
