Participation in cervical screening by Indigenous women in the Northern Territory: a longitudinal study

Objective: To investigate the effectiveness of the Northern Territory Women's Cancer Prevention Program in improving cervical screening participation for Indigenous women. Design: Descriptive longitudinal period prevalence study. Participants: All NT resident women aged 20-69 years who had at least one Pap smear recorded on the NIT Pap Smear Register between 1997 and 2004. Main outcome measures: Indirectly estimated percentage of NT Indigenous women in rural and remote areas with a predominantly Indigenous population (accounting for 55% of the NT Indigenous population) who participated in screening, in biennial periods between 1997 and 2004. Participation by all eligible NT women (both Indigenous and non-Indigenous) is also reported by region for the same period. Results: In 1997-1998, estimated participation for Indigenous women was about half the national rate (33.9% [95% Cl, 32.6%-35.2%] v 63.9% [95% Cl, 63.8%-63.9%]). Participation increased to 44.0% (95% Cl, 42.7%-45.4%) in 1999-2000, and changed little thereafter; participation was higher in the Top End compared with Central Australia, and varied from 16.6% to 75.0% between remote areas. Participation rates for all women living in rural/remote regions were lower than those in urban regions. Conclusions: Recruitment of Indigenous women for cervical screening has improved since 1999. This may have partly contributed to the fall in their cervical cancer incidence and mortality in recent years. Although in most areas Indigenous participation is lower than national levels, in one area it was considerably higher. Improvements can be achieved by learning from these communities, to further close the gap in morbidity and mortality between Indigenous and non-Indigenous women.