Breast and cervical cancer screening in an inner-city medical walk-in clinic: Taking advantage of an often missed opportunity

Background: Despite established evidence that screening for breast and cervical cancer reduces mortality in women, screening is underutilized, especially in poor, minority women. We hypothesized that a high percentage of women presenting for care to an inner-city medical walk-in clinic would report inadequate screening for breast and cervical cancer by current standards, accept same-day screening, and comply with recommended follow-up. Methods: To determine how many women presenting to our medical Walk-in Clinic were inadequately screened for breast and cervical cancer and how many were willing to undergo same-day screening, we surveyed all women at this site over a three month period. We then implemented a one-year, same-day screening program and contacted patients with abnormal screening results by letter or phone to encourage follow up. We tracked patients to assess compliance with follow-up. Results: Of the 2,363 women in the initial survey, 1,230 (52%) reported inadequate screening, of whom 55% reported interest in same-day screening. Over the one year screening period, we screened 403 women for breast and/or cervical cancer. Of the 48 women with abnormal Pap tests, compliance with initial Gynecology Clinic follow-up was 56%. Compliance was 49% with mammography appointments, and 77% for follow-up to Breast Clinic for clinical and/or mammographic abnormalities. These compliance rates compare favorably to those for screening performed in more traditional settings. Conclusion: Our results support the establishment of cancer screening programs in nontraditional settings such as walk-in clinics and emergency departments to target patients who are at highrisk for remaining unscreened.