A primary healthcare-based intervention to improve a Danish cervical cancer screening programme: a cluster randomised controlled trial

Abstract

Background: The proportion of non-attenders in cervical cancer screening is high, and should be minimised. A targeted invitation to women not participating for the last 5 years in cervical screening was evaluated to determine whether it would decrease the number of these women. Increasing general practitioners' attention to the screening programme for cervical cancer was also evaluated to determine whether it would increase participation.

Methods: A cluster randomised controlled trial conducted in the county of Aarhus, Denmark. All women registered with a GP were randomised. Regardless of group allocation, all women received a normal invitation. In the intervention arm, GPs were visited to facilitate quality enhancements of the screening programme, combined with a special targeted invitation to women aged 23-59 registered with the GP but not attending screening for the last 5 years. The main outcome was the proportion of non-attenders and the secondary outcome was coverage rate.

Results: 117 129 women registered with 190 GPs were included in the study. 1737 non-attenders had a Papanicolaou smear during follow-up. The decline in non-attenders was 0.87% (95% CI 0.57% to 1.16%) after 9 months in favour of the intervention. A difference of 0.94% (95% CI 0.21% to 1.67%) in the change of coverage rate was observed at 6 months, which increased to 1.97% (95% CI 0.03% to 3.91%) at 9 months in favour of the intervention.

Conclusion: It is possible to decrease the proportion of non-attenders and increase the coverage rate in a screening programme for cervical cancer using a special targeted invitation to non-attenders combined with a visit to GPs. To further improve participation, other barriers must be identified and addressed.