The Fitzroy Valley Pap Smear Register: Cervical screening in a population of Australian Aboriginal women

Abstract

To describe the operation of the Fitzroy Valley Pap Smear Register, a population-based call and recall system for cervical screening for Aboriginal women, and the prevalence of cervical abnormalities in the women screened. Descriptive study. An Aboriginal community in the far north-west of Western Australia. Aboriginal women aged 15 to 69 years, living in the Fitzroy Valley, Kimberley region. Proportion of eligible women on the Register; age distribution of women screened; prevalence of squamous cell abnormalities. In December 1990, there were 507 Aboriginal women on the Register, being 86.9% of the Aboriginal women in the Fitzroy Valley aged 15-69 years. During 1990, 53.6% of the target population were screened; 369 Pap smears were taken from 312 Aboriginal women. Seventy-six (24.3%) had never previously been screened. Considering only the first smear for each woman in the study period, 10.6% showed minor abnormalities, and 1.6% (95% confidence interval [CI], 0.2%-3.0%) had cervical intraepithelial neoplasia (CIN I, II or III); 2.6% has smears showing definite evidence of human papillomavirus (HPV) infection. For 15-19 year olds the prevalence of CIN was 4.7% (95% CI, 1.0%-13.3%). The study shows how an inexpensive call and recall system can ensure good coverage of cervical screening in a group of women who would otherwise be under-screened. The overall prevalence of CIN in Aboriginal women in the Fitzroy Valley was lower than the figure for all Victorian women (3.6%--data from the Victorian Cytology Service). Although the numbers are small, the relatively high prevalence of CIN in young women is of some concern, and emphasises the importance of regular screening in this group.