Printer friendly

Cervical cancer is a preventable disease. At the present time cervical screening is acknowledged to be the most effective approach to controlling this cancer. Central to the success of any screening programme is its ability to identify, reach and screen the defined target population.

Thirty-five studies published from 1987 to 1999 fulfilled the inclusion criteria for the review. Each study was thoroughly examined for its methodological quality. Of these, 19 studies had evaluated the effectiveness of sending letters that invited women to come for cervical screening. Eight of the 9 studies for which relative risks could be calculated, found a statistically significant improvement in screening uptake in the groups of women who were sent invitation letters compared with those who were not (control groups). Owing to statistical heterogeneity among the studies, however, a pooled summary estimate was not calculated. The authors' conclusions were therefore based on individual study quality and should be interpreted with caution.

Six studies evaluated the effectiveness of different educational interventions. Although 5 of the 6 found these interventions to be beneficial compared with controls the benefit was neither statistically nor clinically significant. Furthermore, it was not clear which particular educational intervention-i.e. print, video/slides, interpersonal communication-was most effective. Evidence with regard to telephone invitations, interpersonal communication, counseling and providing transportation incentives was limited owing to lack of good-quality studies.

Sub-group analyses of the included studies would have been useful in terms of setting (general practice clinic, community or health management organization), age group and access to care of those screened.

The authors concluded that there was some evidence supporting support of the use of invitation letters. They also found limited evidence to support educational interventions in increasing the uptake of cervical screening.

The authors looked into informed uptake of cervical screening as an outcome, but this was not considered by any study.

This Cochrane review was last updated in 2001. The search strategy of Jepson et al. (1) was used, which was comprehensive and included unpublished studies without any language restrictions. Two reviewers screened the studies while one of the authors extracted the data, which were presented clearly. However, following additional information would have been useful: (i) literacy rate of countries where studies were done, (ii) level of education of the women studied; (iii) language used in writing the intervention letters; (iv) cost per woman screened of the particular intervention; and (v) the insurance status of the women screened.

The full RHL commentary also includes sections on: