Study Protocol for the Most Effective Recall Method in a Cervical Cancer Screening Program in Klang, Malaysia


Background: Cervical cancer is the second most common cancer among Malaysian women with an ASR of17.9 and a mortality rate of 5.6 per 100,000 population in 2008 (GLOBOCAN, 2008). The 5 year prevalence wasestimated to be 14.5 per 100,000 population. As the second most common cancer affecting productive females,cervical cancer imposes an impact to the socioeconomic aspect of the country. However, the poor uptake ofcervical cancer screening is a major problem in detecting early pre-cancerous lesions and thus, delay in initiatingtreatment for cervical cancer. Realizing the urgency to increase the uptake of PAP smear, besides enhancing thepromotion of PAP smear screening for women above 35 years old, the call-recall system for pap smear screeninghad been piloted in one of the suburban districts which aimed to improve regular participation of women forcervical and breast cancer screening. This is of public health importance as identifying the best feasible optionto increase patient’s respond to participate in the screening program effectively in our setting will be helpfulin implementing an organized regular population based screening program tailored to our setting. The pilotprogram of cervical cancer screening in Klang was an opportunity to assess different options in recalling patientsfor a repeat pap smear to increase their participation and adherence to the program. Methods and
Results: Thiswas a population based randomized control trial. Women aged 20-65 years in the population that matched theinclusion and exclusion criteria were re-called for a repeat smear. There are four different intervention groups;letter, registered letters, short messages services (SMS) and phone calls where 250 subjects were recruited intoeach group. Samples were generated randomly from the same population in Klang into four different groups.The first group received a recall letter for a repeat smear similar to the one that has been given during the firstinvitation. The intervention groups were either be given a registered letter, an SMS or a phone call to re-callthem. The socio-demographic data of the patients who came for uptake were collected for further analysis. Allthe groups were followed up after 8 weeks to assess their compliance to the recall.
Conclusions: The study willprovide recommendations about the most effective methods for recall in a population based pap smear screeningprogram on two outcomes: i) patients response; ii) uptake for repeat pap smear.