Can cervical cancer be prevented by a see, screen, and treat program? A pilot study

OBJECTIVE: Our purpose was to determine the feasibility of providing a cervical screening facility to the underprivileged communities through an educational program and a mobile clinic in which cytologic smears could be taken, screened immediately, and, when appropriate, the patients treated on site with minimal delay. STUDY DESIGN: A prospective study was conducted in two parts on 5045 patients living in squatter areas around Cape Town, South Africa. The patients were educated about cervical cancer and its prevention and were offered a free Papanicolaou smear taken in a fully equipped mobile clinic. These were immediately stained and processed. Patients diagnosed cytologically as having high-grade squamous intraepithelial lesions were assessed colposcopically and, when indicated, immediately treated by large loop excision of the transformation zone under local anesthesia. RESULTS: In phase 1, colposcopy was done in the nearest colposcopy clinic, 20 km from the screening site. The defaulter rate was 66%. In phase 2, colposcopy and treatment were offered on site. A total of 97% of patients referred for colposcopy attended the clinic, and all patients requiring treatment have been adequately treated. CONCLUSION: With a rapid turnaround time for the reporting of cytologic results and given a colposcopy and treatment facility available located at the screening site at the time women receive their results, the majority of women will undergo colposcopy and treatment.