A Mobile Unit: An Effective Service for Cervical Cancer Screening Among Rural Thai Women

Int J Epidemiol. 1999 Feb;28(1):35-9. doi: 10.1093/ije/28.1.35.

Abstract

Background: We carried out a systematic screening programme using a mobile unit with the purpose of increasing use of Papanicolaou (Pap) smear screening among rural Thai women. The mobile unit campaign was carried out initially between January and February 1993 and then in 1996 in all the 54 rural villages in Mae Sot District, Tak Province, northern Thailand.

Methods: To evaluate the effect of the programme on changes in knowledge and use of screening, we compared the results of three interview surveys of women, 18-65 years old, in villages selected by systematic sampling for each survey; first in 1991 (before the operation of the programme), secondly in 1994 (one year after the first screening campaign), and last in 1997 (one year after the second campaign). This report also compares data on Pap smears taken by the mobile unit with other existing screening services in the study area.

Results: A total of 1603, 1369, and 1576 women respectively, participated in each survey. The proportion of women reported knowing of the Pap smear test increased from 20.8% in 1991 to 57.3% in 1994 and to 75.5% in 1997. The proportion of women who had ever had a Pap smear increased from 19.9% in 1991 to 58.1% in 1994 and to 70.1% by 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers identified among the Pap smears taken by screening services in the area between 1992 and 1996. The rate of CIN III was 3.5/1000 smears in this screening programme, which was 5.2 and 2.0 times higher than the rates in the maternal and child health/family planning clinic and the annual one-week mass screening campaign respectively.

Conclusions: The use of a mobile unit may be an effective screening programme in rural areas where existing screening activities cannot effectively reach the female population at risk.

PIP: A mobile cervical cancer screening campaign was conducted in both 1993 and 1996 in all 54 rural villages in Mae Sot District, Tak Province, in northern Thailand. The impact of the program on women's knowledge of cervical cancer and uptake of Pap smear testing was evaluated in 3 rounds of survey of women 18-65 years of age from the area served by the mobile unit. 1603 women were interviewed in 1991 before program implementation, another 1369 women were surveyed in 1994, and 1576 were enrolled in the 1997 survey. Awareness that cervical cancer can be asymptomatic increased from 19.5% in the baseline survey to 52.8% in 1994 and 63.9% in 1997. The proportion of women knowledgeable about Pap smears increased from 20.8% in 1991 to 57.3% in 1994 and 75.5% in 1997. The proportion of women who had ever had a Pap smear rose from 19.9% in 1991 to 58.1% in 1994 and 70.1% in 1997. Screening by the mobile unit accounted for 85.2% of all cervical intraepithelial neoplasia (CIN) III and all invasive cancers detected by Pap smear in the study area during 1992-96. The rate of CIN III was 3.5/1000 smears in the mobile screening program compared with 0.7/1000 in the maternal-child health/family planning clinic and 1.8/1000 in the annual 1-week mass screening campaign. These findings confirm that a mobile unit is an effective tool in rural areas where existing screening activities cannot reach all the women at risk of cervical cancer.

MeSH terms

  • Adult
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Mass Screening / methods*
  • Mass Screening / psychology
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Mobile Health Units*
  • Papanicolaou Test*
  • Program Evaluation
  • Rural Health Services*
  • Thailand
  • Uterine Cervical Neoplasms / prevention & control*
  • Vaginal Smears* / psychology
  • Vaginal Smears* / statistics & numerical data