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The FoCaS (Forsyth County Cancer Screening) Project was one of six projects funded by the National Cancer Institute "Public Health Approaches to Breast and Cervical Cancer" initiative. The goal of this project was to improve the use of breast and cervical cancer screening among low-income, predominately African-American, women age 40 and older. Strategies implemented in the intervention city included public health clinic in-reach strategies (chart reminders, exam room prompts, in-service meetings, and patient-directed literature) and community outreach strategies (educational sessions, literature distribution, community events, media, and church programs). Baseline and follow-up data from independent cross-sectional samples in both the intervention and comparison cities were used to evaluate the effects of the intervention program. A total of 248 women were surveyed at baseline, and 302 women were surveyed 3 years later at follow-up. The proportion of women reporting regular use of mammography increased (31 to 56%; P0.001) in the intervention city. In the comparison city, a nonsignificant (ns) increase in mammography utilization was observed (33 to 40%; P = ns). Pap smear screening rates also improved in the intervention city (73 to 87%; P = 0.003) but declined in the comparison city (67 to 60%; P = ns). These relationships hold in multivariate models. The results suggest that a multifaceted intervention can improve screening rates in low-income populations. These results have important implications for community-based research and efforts in underserved populations.

This paper reports results of a project designed to examine factors related to compliance with referral for follow-up and treatment of cervical dysplasia. Women studied had cervical dysplasia diagnosed by Pap smear between May 1989 and April 1990. These women had regular follow-up at the gynecology clinic of the Reynolds Health Center in Winston-Salem or at one of 14 county health departments in northwestern North Carolina. Data were collected by chart review, and included age, race, place of residence, marital status, parity/gravidity, education, previous papillomavirus infections, method of payment, and previous Pap smear results. Patients were traced through the treatment protocol, and compliance was assessed at each appointment. In these women of low socioeconomic status, approximately one third of those referred for treatment of dysplasia were noncompliant with referral.