Single-visit program for cervical cancer prevention in a high-risk population

Abstract

Objective: To evaluate the feasibility of a single-visit cervical neoplasia screening and intervention program. Methods: A sample of asymptomatic, nonpregnant, indigent, adult women who had not had a Papanicolaou smear for at least 2 years ( N = 126) was recruited through Spanish-language media in Orange Country, California. Women who volunteered underwent a free, single-visit program combining a health questionnaire, education, an immediately read Papanicolaou smear, loop electrosurgical excision of the transformation zone for those with dysplastic cytology, and an exit questionnaire gauging satisfaction and educational impact. Main outcome measures included the frequency of cervical cancer risk factors and barriers to health care, incidence of cervical neoplasia, feasibility, short-term educational impact, and acceptability of interventions. Results: All 126 patients had at least one cervical cancer risk factor; 101 (80.2%) reported at least one barrier to health care. One hundred sixteen (92.1%) had a normal Papanicolaou smear, and three (2.4%) with a mildly atypical smear were referred for colposcopy. Seven (5.6%) patients had a dysplastic smear and underwent same-day loop electrosurgical excision of the transformation zone without complication, with histology revealing koilocytotic atypia (two patients), cervical intraepithelial neoplasia (CIN) I (two), CIN II (two), and CIN III (one). No case of invasive cervical carcinoma was identified. The mean time from performance of Papanicolaou smear to receipt of cytologic results was 2.2. hours, and the mean total visit time was 3.6 hours. Patients found the single-visit program to be both beneficial and satisfying. Conclusion: This single-visit program is feasible and may overcome barriers to the diagnosis and management of cervical neoplasia in patients at high risk.