Sanchia Aranda: Cancer end in sight

FROM one health professional to many others, this is a call to arms — a call to help end cervical cancer as we know it.

Alarmingly, only one in two Australian women aged 20–69 years has a Pap test every 2 years. Even more revealing is the fact that 90% of women diagnosed with cervical cancer haven’t had regular Pap tests.

Why the low uptake?

Young women in particular, and especially those from culturally and linguistically diverse communities, can experience embarrassment at the thought of a Pap test. Some may even assume that having the human papillomavirus (HPV) vaccine eliminates the need for screening, or having had only one sexual partner means that they are not at risk.

Then, of course, there are the usual assumptions around pain, discomfort, or even fear of results. The relative rarity of cervical cancer because of organised screening in Australia may also make some women think they are not at risk.

In reality, 785 women died of cervical cancer in 2012 and all of these deaths were potentially avoidable through regular Pap tests and the HPV vaccine.

So, how do we change this and end cervical cancer as we know it? Yes, women need to act, and the Cancer Institute NSW is driving the “need to screen” message through its Peace of Mind mass media campaigns. However, it is GPs who need to spearhead this campaign and help women turn knowledge into action.

GPs and practice nurses are at the coal face, armed with the knowledge and the means to inform and educate women about the essential need to screen every 2 years.

We know that GPs play a key role in a woman’s decision to participate in cancer screening. In NSW, 82% of Pap tests are performed in a general practice setting. However, formative research undertaken by the Cancer Institute NSW suggests women feel GPs don’t prompt them enough to screen, especially for first timers.

Internal analysis by the Cancer Institute NSW shows wide variation in the number of Pap tests performed in general practices across NSW with some performing none or very few. It is imperative that these practices do still initiate conversations with women about screening and refer on as appropriate, such as to women’s health nurses.

Invitations and reminders provide an important prompt for screening attendance. The most reliable reminder system provided to women in NSW is the Pap Test Register (PTR). However, the PTR can only remind women about screening when they are overdue for their next test. It cannot reach women who have never been screened. GPs are critical to prompting a first screen.

An unpublished pilot study commissioned by the Cancer Institute NSW found strong evidence that a letter of invitation sent to the patient from a GP, with an appointment date for screening, increased screening uptake.

To make such reminders feasible in the busy general practice setting, we sought to increase cervical screening rates (and increase early detection and prevention of cervical cancer) through this pilot project to test the effectiveness of sending GPs an electronic reminder to coincide with their patients receiving a reminder letter from the PTR.

The result was extremely positive with 60% more women attending for their Pap test within 2 months of receiving their letter if the GP was also sent the electronic reminder. This could mean that the GP either sent the patient a letter directly, or set up an alert to remind patients about the need to screen at their next appointment. The Cancer Institute of NSW is planning to implement this program more widely across the state in the future.

Getting women through the door to take that test requires more from GPs than simply telling women this is something they “need to do”. Ensuring reminder systems are in place and taking the time to discuss screening as part of routine care are critical general practice roles.

Women want a trusted adviser; someone who will educate them and placate their concerns (or fears) about the procedure and point out the advantages that peace of mind can bring to their overall health and wellbeing.
 

Professor Sanchia Aranda is the Deputy CEO of the Cancer Institute NSW — a state government agency dedicated to the control and cure of cancer through prevention, detection, innovation and information. www.cancerinstitute.org.au