Effects and sustainability of a cervical screening program in remote Aboriginal Australia

Abstract: We assessed the effects of an organised cervical screening program, using a population–based cervical cytology register, for Aboriginal women in the Fitzroy Valley, a remote part of the Kimberley region of Western Australia. Comparison of age–specific screening rates in the area during 1987–88, 1990–92 and 1993–94 showed that establishing the program in late 1989 was accompanied by dramatic increases in cervical screening rates, ranging from two– to over fourfold, with the largest increases in women aged 50 years and over. Following the departure of the coordinator in early 1993, screening rates decreased to between 76 per cent and 29 per cent of their 1990–92 levels, with the largest decreases occurring in the 40–49 and 60–69 years age groups. Rates were still above 1987–88 levels for most age groups. Of 545 women screened during 1991–92, 65 per cent had undergone a second Pap smear within the follow–up period of two to four years. Among women recommended for a repeat smear in two years, the probability of having a second smear was negatively associated with age (log–rank statistic = 35.58, 4 df, P < 0.0001). Follow–up of smears recommended for repeat in 12 months or earlier was less adequate in 1993–94 (46 per cent) than in 1991–92 (75 per cent). The program was successful in recruiting a large proportion of eligible women within a relatively short time, but coverage, especially of older women, was not sustained after a decline in the functioning of the recall system owing to staffing and organisational changes.