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Cervical cancer-Thailand
[Reproduced from the Reproductive Health Outlook (RHO) Website (http://www.rho.org), 2000.]
Cervical cancer is the most common type of cancer among women in Thailand. In the early 1990s a mobile unit program was developed in the Mae Sot District, Tak Province, to improve screening coverage and knowledge of cervical cancer among rural Thai women.
Since the 1970s cervical cancer screening in the Mae Sot District hospital has been performed mainly through the maternal and child health/family planning services. A one-week mass screening campaign in which women can receive a Pap smear at no charge has been conducted in the hospital since 1986. Despite the availability of these services, a 1991 survey of women aged 18 to 65 revealed that only 21 percent knew about the Pap test, and only 20 percent had ever been screened.
In order to improve screening coverage in rural Thailand and to increase awareness of cervical cancer, a mobile unit program was established in 1993. Supported by the Provincial Health Office, the mobile screening unit targeted women between the ages of 25 and 60. Mobile unit activities included providing education, asking health center workers and trained village health communicators to personally invite women to the screening program, and collecting Pap smears throughout all 54 rural villages in the district. Pap smears were provided free of charge and were obtained by trained public health nurses under the supervision of the project physician at the health center or the village primary school in each village. All Pap slides were sent to the cytology laboratory at the hospital. After the first campaign was conducted in January and February 1993, another campaign was implemented in 1996.
To evaluate the program's effect on knowledge and use of cervical cancer screening, the results of three interview surveys of women aged 18 to 65 were compared. The first survey was completed in January 1991, before the program had been established; the second was completed in January 1994, one year after the first screening campaign; and the third was completed in January 1997, one year after the second campaign. Survey results include:
- The percent of women who could identify cervical cancer as the most common cancer in women rose from 31 percent in 1991 to 66 percent in 1994 and 69 percent in 1997.
- The belief that women can have asymptomatic cervical cancer increased from 20 percent in 1991 to 53 percent in 1993 and 64 percent in 1997.
- The proportion of women who knew about the Pap test rose from 21 percent in 1991 to 57 percent in 1994 and 76 percent in 1997.
- Of the women who knew about the Pap smear, the proportion who understood that it could detect asymptomatic cervical cancer grew from 78 percent in 1991 to 92 percent in 1993 and remained at 92 percent in 1997.
- The proportion of women who had ever had a Pap test increased from 20 percent in 1991 to 58 percent in 1994 and 70 percent in 1997.
- The mobile unit screening program became the most commonly reported service for Pap screening among rural Thai women.
- The mobile unit effectively targeted older women. More smears of women older than 25 and particularly women older than 45 were taken by the mobile unit than by the other screening services.
- The mobile unit accounted for 85 percent of all cervical intraepithelial neoplasia (CIN) III and all invasive cancer identified among the Pap smears examined in the district from 1992 to 1996.
- Health education, personal invitation, and smear-taking activity are crucial components of cervical cancer screening programs.
- Mobile unit may be an effective screening program for early detection of cervical cancer among women in rural areas where existing screening services cannot reach female populations (particularly older populations) at risk.
Information adapted from Swaddiwudhipong, W. et al. A mobile unit: an effective service for cervical cancer screening among rural Thai women. International Journal of Epidemiology 28:35-39 (1999). This information is from PATH.
