Breast and cervical cancer screening of poor, elderly, black women: clinical results and implications. Harlem Study Team.

Our objective is to describe the clinical findings from a nurse-practitioner-based breast and cervical cancer screening program for poor, elderly, black women. We designed a cross-sectional descriptive study set at an urban public hospital medical clinic. All women 65 years of age and older were eligible to be screened. We measured these main outcomes: rates of participation, abnormal tests, and neoplasia. Women were offered screening during a routine visit. Of 689 women, 491 (71%) participated. Mammography was completed by 66% of women; one had stage 1 cancer, and 76% were negative. Among the women (24%) with abnormal mammograms, the overwhelming majority were diagnosed with benign lesions. For ten of 450 women completing Papanicolaou (Pap) smears, results were suspicious or positive for malignancy, for a prevalence rate of 22.2/1,000 (95% confidence interval [CI] = 8.6/1,000 to 35.8/1,000). Three were subsequently designated falsely positive; five had confirmed cervical neoplasia; and two had other reproductive malignancies. Two women with negative smears also had neoplasia: one with vulvar cancer and one with human papilloma virus (HPV) infection and cervical neoplasia, for a total of six cervical neoplasias. Interestingly, one-fifth of women with a hysterectomy had an intact cervix, including one with cervical neoplasia. Nearly one-third of women with abnormal Paps or mammograms failed to complete follow-up. Success of screening programs for the elderly will depend on the risk group targeted, careful examination, degree of sensitivity and specificity of the tests, and acceptability of follow-up diagnosis and treatment.