Limitations in Correspondence Programs for Cervical Cancer Screening: Who Are the Women We Are Missing?

This study sought to identify factors associated with gaps in the correspondence program and the characteristics of those women who are not reached with a mailed invitation to screening within an organized cervical cancer screening program.

This population-based, retrospective observational study examined the factors associated with failed correspondence mailings as part of the Ontario cervical cancer screening program. Administrative databases were used to identify eligible women who were overdue for screening or never screened yet did not receive an invitation to screening as a result of a failed mailing. These women were further characterized on the basis of age, affiliation with a primary care physician, and use of other health services (Canadian Task Force Classification II-2).

A total of 1 350 425 women were eligible, of whom 1 064 637 had a successful mailing (78%). Women who were overdue for screening and who had a failed correspondence were more likely to be younger than 50 (72.5%) and associated with a primary care physician (61.2%), and 66.7% had three or more health care encounters in the preceding 3 years. Underscreened and never-screened women were also more likely to be younger than 50, but only 15% were associated with a primary care physician and only 18.2% had health care encounters in the previous 3 years.

This is one of the first studies to evaluate the incidence of failed mailings within correspondence in organized screening programs. Women who are underscreened or never screened are infrequent users of health care services and tend not to have a primary care physician, thus making them less accessible to traditional outreach methods and at further risk of being non-compliant with screening.