DELIVERING BREAST AND CERVICAL-CANCER SCREENING SERVICES TO UNDERSERVED WOMEN .1. LITERATURE-REVIEW AND TELEPHONE SURVEY

Although breast and cervical cancer screening procedures have been sho wn to reduce morbidity and mortality, many women are not using these s ervices. These women are likely to be older, of ethnic or racial minor ity, of low socioeconomic status, less educated, underinsured, or livi ng in rural locations. Many breast and cervical cancer screening progr ams employ strategies to increase use. In order to identify and assess those strategies, we reviewed the literature and completed a telephon e survey, altogether assessing 61 programs. Our study identified sever al strategies and found that not all strategies work for all women. Ma nagement systems directed to both patients and providers consistently are effective for most underserved women. Community-based outreach and integration of preventive services at the primary health care (PHC) s ite are effective strategies for both African American and Hispanic wo men. Use of mass media has been successful when targeted toward Hispan ic women, but not when targeted toward African American women. Mobile units and integration of preventive services at PHC sites are effectiv e strategies for elderly women. In many cases, a combination of strate gies may be effective. Programs should employ strategies best suited t o their target populations.