IMPLEMENTATION OF A BREAST AND CERVICAL-CANCER SCREENING-PROGRAM IN APUBLIC HOSPITAL EMERGENCY DEPARTMENT

Study objective: To assess the feasibility and yields of screening for breast and cervical cancer in an urban public hospital emergency depa rtment. Methods: Women who presented to the ED of a large, urban publi c hospital during the study period with nonurgent conditions were elig ible for a Papanicolaou test (Pap smear) and a clinical breast examina tion (CBE) if they were 18 years of age or older, and for a mammogram if they were 40 years of age or older, provided they had not had the s creening examination within the past year. The Pap smear and CBE were performed by a nurse, and mammography was scheduled for a later date. Women with gynecologic complaints were excluded. Results: On the basis of screening history, medical status, and age, 1,850 (32%) of the 5,8 30 women seen in the ER during the 23-month study period were eligible for both mammography and CBE, and 2,361 (41%) were eligible for Pap s mears. Of these women, 116 (6%) completed mammography and CBE, and 644 (27%) received Pap smears. Among screened women, 10 (9%) and 20 (3%), respectively, had results that were suspicious or positive for breast or cervical cancer. Follow-up rates were low: 20% for breast screenin g and 50% for Pap smears. Among those receiving follow-up, 1 woman was found to have breast cancer and 8 were found to have cervical neoplas ia. Conclusion: ED cancer screening was feasible and yielded a high ra te of cancer detection. Program efficiency was hampered by low volume and high numbers of patients lost to follow-up after abnormal screenin g results. Greater integration into the acute care setting and more in tensive recruitment and follow-up strategies are needed to maximize th e potential yield and cost-effectiveness of such programs.