Access to colposcopy services for high-risk Canadian women: Can we do better?

Background: Despite overall decreasing mortality from cervical cancer, selected groups of Canadian women continue to have suboptimal access to diagnostic and treatment interventions for cervical cancer. in this paper, we present an evaluation of a colposcopy program developed to improve attendance for colposcopy in a lower socio-economic and immigrant population. Methods: All women attending the North Hamilton Community Health Centre (CHC) who required colposcopic assessment and were referred to a newly developed colposcopy program based at the CHC were evaluated. Attendance rates for consultation, follow up and treatment in women referred for colposcopy were compared retrospectively for the CHC-based colposcopy program and concurrently with the regional colposcopy clinic (RCC). Results: Women referred to the CHC colposcopy program had a significant reduction in their no-show rate after the introduction of the locally based colposcopy program (17.2% vs. 1.3%, p<0.01). Comparing the same time periods, there was no significant reduction in the default rate at the RCC (2.5% vs. 3.3%, p=0.21). Despite serving a population of women who were at higher risk for non-attendance, patients at the CHC had a default rate for appointments similar to that of the RCC (1.3% vs. 3.3%, p=0.55) after the introduction of the local colposcopy program. Conclusions: Lower socio-economic status and immigrant women receiving care from a CHC-based colposcopy program had a significant decrease in their no-show rate for colposcopic evaluation after the introduction of the on-site program. Consideration must be given to locating diagnostic colposcopy programs in settings more accessible to women who require these services the most.