PoPulationand Public HealtH etHics

using PersonalizeD letters
oF invitation to increase
ParticiPation in cervical
cancer screening
France Filiatrault, M.sc., Michel Désy, Ph.D. and Isabelle Laporte, M.D.
Institut national de santé publique du Québec [Quebec public-health institute]
Montreal QC
FRanCe.FIlIatRault@InsPq.qC.Ca
An opinion on the case presented in this paper has been issued by Quebec’s Comité d’éthique de
santé publique [public health ethics committee]. 1
Introduction
The goal of this pilot project was to increase participation in cervical cancer
screening among women who had never had a Papanicolaou (Pap) test or had
not had one in the past three years or more, by mailing a personalized letter
to their homes. This goal was consistent with the objective of the public
health program of Quebec’s ministry of health and social services, which is
to achieve a 10 per cent reduction in cervical cancer mortality among women
ages 25 to 64. 2
There are few data on the characteristics of women who do not take Pap tests
or who do not take them at least once every three years. According to the
data for Quebec in the 2003 Canadian Community Health Survey, the following
factors appear to be associated with low participation in cervical cancer
screening: low household income, lack of a family physician, lack of understanding
of French or English, low level of education, and, in the case of older
women, living alone. “[translation] However, the vast majority of unscreened
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