Effectiveness of letters to Cape Breton women who have not had a recent Pap smear.

Nova Scotia, and especially Cape Breton, has high cervical cancer incidence and mortality rates. Letters were sent to 15,691 unscreened and 6,995 under-screened women from Cape Breton Island encouraging them to obtain a Pap test. Controls were 61,510 unscreened women and 32,996 under- screened women in mainland Nova Scotia who were not sent letters. For this cohort study, the provincial Health Card Number database and Provincial Cytology Registry were linked. Having a Pap smear was associated with having received a letter (OR = 1.64), having been previously under-screened rather than unscreened (OR = 1.85), with youth and with higher income (OR = 1.13). After receiving a letter, women in Aboriginal, Mixed Black, Acadian, and rural communities had smear rates similar to those of other women. Being previously unscreened, rather than under-screened, was associated with higher rates of abnormalities (OR = 1.62), indicating greater need for early detection and treatment to prevent invasive cancer. While one-time letters to women improved the Pap smear screening rates, multiple, continuous interventions are needed to make a more substantive improvement in these rates.