1. Introduction
pain, Cancer
CERVICAL CANCER, VAGINAL BLEEDING, CERVICAL CANCER, CANCER
(1) Background: Aboriginal women have a higher mortality from cervical cancer, yet cervical screening rates are lower than for other Australian women. (2) Methods: A randomised controlled trial of reminder letter vs. phone call/SMS for routine cervical screening testing in an Aboriginal Community Controlled Health Organisation in NSW. (3) Results: 256 women aged between 25 and 74 who were due for cervical screening were randomised to receive a reminder letter (and up to two further letters for non-responders) or a phone call (followed by up to two SMS) to attend the screening. A total of 15 women (12.5%) attended for cervical screening test within 3 months following a letter, and 24 women (17.6%) after a phone call/SMS reminder; this difference was not significant (Cervical cancer screening, along with human papillomavirus (HPV) vaccination, can play a role in the elimination of cervical cancer. Although the age-standardised incidence of cervical cancer was 2.2 times higher for Aboriginal and Torres Strait Islander women than for other Australian women (13.9 per 100,000 vs. 6.4 per 100,100 in 2011-5) [The National Cervical Screening Program aims to prevent cervical cancer by early detection through screening. Screening is available to women and people with a cervix aged between 25 and 74 who have ever had sexual contact [Where data was collected, the cervical screening participation rate for Aboriginal and Torres Strait Islander women is 40%, but participation rates range from 19.9% to 63.5% [The National Cancer Screening Register (NCSR) (incorporating previously state-based cervical screening registers) provides reminders to participants regarding screening. In 2016, of more than one million women who were sent a reminder letter by a cervical screening register, 31% were rescreened within 3 months [Primary care, including ACCHOs, plays an important role in preventive care, including in promoting screening for cervical cancer; in a study of 1,107,233 women in Queensland in 2013-7, ACCHOs recorded higher screening rates than mainstream services [Reminder systems have been used in Aboriginal health services for over thirty years [Under-screened and never-screened women are at higher risk of cervical cancer. Some women decline a cervical screening test (CST) collected by speculum because of its invasive nature. In 2017, self-collected CST became available for women over 30 years of age who were 2 years overdue for screening and who had declined a speculum examination. In a qualitative study involving interviews with 94 Indigenous women aged 25–74 in NSW, many women were not aware of the new option for self-collected specimens, and women felt unwilling to complete a self-collected test for fear of using an incorrect method [Primary health services also play a role in reviewing those with symptoms of cervical cancer, for example, irregular vaginal bleeding or pain, by providing investigation and referral to specialist gynaecological services, for example, for colposcopy. In contrast to reminders, which are used for preventive care, recall services are designed to inform clients of abnormal results, and to encourage them to attend for follow-up treatment. Primary health services provide recalls for abnormal results on cervical screening tests or other investigations, for example, by phoning at different times of the day, mailing a recall letter, and if the person is not contactable, mailing a registered mail letter, to ensure that at least three documented attempts have been made at contacting the person.Reminders for preventive care are considered part of quality primary care but may be both time-consuming and are not renumerated by funding systems. The aim of this project was to determine which mode of reminder was most likely to result in presentation for cervical screening and was most cost-effective as part of quality improvement. 