Doyle J P, Parker R M, Jacobson T A, McNagny S E
Division of General Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Am J Prev Med. 1996 Sep-Oct;12(5):345-50.
Despite established evidence that screening for breast and cervical cancer reduces mortality in women, screening is underutilized, especially in poor, minority women. We hypothesized that a high percentage of women presenting for care to an inner-city medical walk-in clinic would report inadequate screening for breast and cervical cancer by current standards, accept same-day screening, and comply with recommended follow-up.
To determine how many women presenting to our medical Walk-In Clinic were inadequately screened for breast and cervical cancer and how many were willing to undergo same-day screening, we surveyed all women at this site over a three month period. We then implemented a one-year, same-day screening program and contacted patients with abnormal screening results by letter or phone to encourage follow up. We tracked patients to assess compliance with follow-up.
Of the 2,363 women in the initial survey, 1,230 (52%) reported inadequate screening, of whom 55% reported interest in same-day screening. Over the one year screening period, we screened 403 women for breast and/or cervical cancer. Of the 48 women with abnormal Pap tests, compliance with initial Gynecology Clinic follow-up was 56%. Compliance was 49% with mammography appointments, and 77% for follow-up to Breast Clinic for clinical and/or mammographic abnormalities. These compliance rates compare favorably to those for screening performed in more traditional settings.
Our results support the establishment of cancer screening programs in nontraditional settings such as walk-in clinics and emergency departments to target patients who are at high risk for remaining unscreened.
尽管已有证据表明乳腺癌和宫颈癌筛查可降低女性死亡率，但筛查的利用率仍较低，尤其是在贫困的少数族裔女性中。我们推测，到市中心一家无需预约的医疗诊所就诊的女性中，很大一部分会报告按照当前标准对乳腺癌和宫颈癌的筛查不足，接受当日筛查，并遵守推荐的后续检查。
为了确定到我们的无需预约的医疗诊所就诊的女性中有多少人对乳腺癌和宫颈癌筛查不足，以及有多少人愿意接受当日筛查，我们在三个月的时间里对该诊所的所有女性进行了调查。然后我们实施了一项为期一年的当日筛查计划，并通过信件或电话联系筛查结果异常的患者，鼓励她们进行后续检查。我们跟踪患者以评估其对后续检查的依从性。
在初始调查的2363名女性中，1230名（52%）报告筛查不足，其中55%表示有兴趣接受当日筛查。在一年的筛查期内，我们对403名女性进行了乳腺癌和/或宫颈癌筛查。在48名巴氏试验异常的女性中，对最初妇科诊所后续检查的依从率为56%。乳房X光检查预约的依从率为49%，因临床和/或乳房X光检查异常而到乳腺科进行后续检查的依从率为77%。这些依从率与在更传统环境中进行的筛查的依从率相比具有优势。
我们的结果支持在无需预约的诊所和急诊科等非传统环境中建立癌症筛查计划，以针对那些未接受筛查风险较高的患者。
