Austad K, et al. - Researchers determined the factors influencing the use of cervical cancer screening services and loss to follow-up in rural Guatemala. The quantitative and qualitative findings of this study call for cervical cancer screening programs in Guatemala so that uptake of screening services by eligible women and follow-up after a first abnormal screen may be improved.

Methods

• In this mixed-methods study of a cytology-based screening program in rural Guatemala, researchers analyzed data of all patients from 2013 to 2014 via a retrospective electronic chart review.
• They analyzed progression through care and calculated loss-to-follow-up rates.
• Based on self-reported historical data available in the chart review, they also analyzed the previous experiences patients had with cervical cancer screening.
• At the time of screening, they performed structured interviews with a subset of individuals to explore social supports and barriers to screening and engagement in care.

Results

• A total of 515 women (median age, 36 years) were analyzed.
• Of cytologically screened women, concern for neoplastic changes were seen in 0.83%, and half of these resulted in biopsy-proven cervical intraepithelial neoplasia.
• Severe inflammation was detected in an additional 9.9%.
• The observed rate of loss to follow-up was 11.3%.
• They noted that all losses to follow-up occurred for severe inflammation, not for cervical intraepithelial neoplasia.
• According to historical data, previous screening had been performed in 73% of the cohort and they had high levels of loss to follow-up (57.4%).
• Cost, lack of social supports, transportation, distrust in public facilities, long turn-around times, and failure to return test results or offer follow-up treatments were all reported as factors that promoted loss to follow-up, as revealed via qualitative interviews.