Cervical cancer currently is among the most common causes of cancer-related death in women. Over 13,000 American women will get this disease in 2002 alone, and one out of every 117 women will be diagnosed with cervical cancer in her lifetime. Cervical cancer is of particular concern to African-American and Hispanic women. According to 1969-96 Surveillance, Epidemiology, and End Results (SEER) data from the National Cancer Institute (NCI), only 60 percent of African-American women diagnosed with cervical cancer will survive for five years, compared with 72 percent of non-Hispanic white women. In addition, among Mexican-American and Puerto Rican women, cervical cancer occurs two to three times more often than among non-Hispanic white women.

Sherri Sheinfeld Gorin, PhD, is Assistant Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health, Columbia University.

Despite some advances in chemotherapy and radiotherapy for the treatment of cervical cancer, surgery remains the primary option. Because of the reliance on surgical tumor removal, the stage at which the disease is diagnosed is crucial to the effectiveness of treatment—the more advanced the cancer, the worse the prognosis. As a result, screening has become a very important means of improving outcomes in cervical cancer patients.

The American Cancer Society (ACS), the NCI, and the American College of Obstetrics and Gynecology (ACOG) recently developed guidelines for cervical cancer screenings, which, thanks to recent studies, have gained broad acceptance in the medical community. The guidelines recommend that all women over the age of 18, and all women who are sexually active, have a Papanicolaou (Pap) test each and every year. The ACS further recommends that if a woman has had three negative Pap tests in a row, she may discuss less frequent testing with her health care provider.

However, surveys conducted over the past ten years have shown that not all physicians are counseling their patients in cancer prevention, particularly with regard to screening for cervical cancer. According to Healthy People 2010, a healthcare initiative from the US Department of Health and Human Services, only 55 percent of primary care physicians counsel women about cancer screening with a Pap test, compared with a target of 85 percent. Strategies for helping change physician practice behavior to include cervical cancer screening are being explored.

Academic detailing, which is a brief focused intervention with a physician, has been found to be effective in changing physician practice behavior. This relatively new approach was developed with the idea that the same methods used by pharmaceutical marketers can be used to communicate the objectives of nonprofit organizations as well. Delivered in the office during spare moments between patients, or before or after hours, academic detailing seems uniquely suited to identifying and addressing the barriers to practice change, which we identified in our studies of urban practices. Supporting information is provided to the physicians in response to specific queries. This critical aspect of academic detailing works in concert with the clinical problem solving approaches generally used by physicians. By focusing educational efforts on the entire office, the goal of academic detailing is to make cervical cancer screening part of the standard routine.

For the past seven years, our team—Drs. Sherri Sheinfeld Gorin, Alfred I. Neugut, Alfred Ashford, Rafael Lantigua, Donald Gemson, and Andrea Troxel, along with Drs. Joshua Zivin and Thomas Wright on this project—has been funded by the NCI, ACS, and the Centers for Disease Control and Prevention (CDC) to use academic detailing to promote cancer screening and prevention among community-based primary care physicians in Northern Manhattan and the Bronx. Our newest trial, a two-arm, randomized clinical study funded by the CDC, is designed to adapt our procedure and extend the use of academic detailing to primary care physicians in Harlem, Washington Heights, the South Bronx, parts of Brooklyn, and, in conjunction with the University of Medicine and Dentistry in New Jersey (UMDNJ), Essex County, New Jersey. The long-term goal of this project is to reduce cervical cancer risk among ethnic and racial minorities by influencing the screening behaviors of their primary care physicians.

Editor’s Note (About the Authors):

Sherri Sheinfeld Gorin, PhD, is Assistant Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health, Columbia University.

Alfred I. Neugut, MD, PhD, is Professor of Medicine and Epidemiology at the Columbia University College of Physicians and Surgeons, Head of Cancer Prevention and Control at the Herbert Irving Comprehensive Cancer Center of the Columbia-Presbyterian Medical Center, and Co-Director of the Cancer Prevention Program at NewYork-Presbyterian Hospital.

Alfred Ashford, MD, is Associate Clinical Professor of Medicine at the Columbia University College of Physicians and Surgeons and Director of Medicine at the Harlem Hospital Center.
Rafael Lantigua, MD, is Professor of Clinical Medicine at the Columbia University College of Physicians and Surgeons.

Donald Gemson, PhD, is Associate Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health, Columbia University.

Thomas Wright, MD, is Associate Professor of Pathology at the Columbia University College of Physicians and Surgeons.

Joshua Zivin, PhD, is Assistant Professor, Department of Health Policy and Management at the Mailman School of Public Health, Columbia University.

Andrea Troxel, ScD, is Assistant Professor of Clinical Biostatistics at the Herbert Irving Comprehensive Cancer Center of the Columbia-Presbyterian Medical Center, and Assistant
Professor of Public Health in the Division of Biostatistics at the Mailman School of Public Health, Columbia University.