Improving Health Communication and Follow-up for Abnormal Pap Smears

Sandra E. Brooks, MD
Professor, Department
of Obstetrics, Gynecology &
Reproductive Sciences

Pre-invasive carcinoma of the cervix, the precursor to invasive carcinoma of the cervix, is a significant public health problem in the U.S. and, in particular, in the city of Baltimore. Although Pap smear screening rates approach 70 percent, nearly one-third of women with a diagnosis of invasive carcinoma of the cervix have either not had a Pap smear within three years or have not had adequate follow-up for an abnormal result.

Fewer than half of the predominantly African American women scheduled to undergo evaluation of an abnormal Pap smear at the University of Maryland School of Medicine’s colposcopy clinic keep their appointment. Given the potential for development of cervical cancer in patients lost to follow up, Dr. Brooks sought to determine if a multi-modality approach would be associated with increased adherence to appointments for colposcopy over that of standard care. The strategy is to empower women to understand their health care needs, encourage them to ask questions about their health and aid them in reducing barriers to keeping their appointments.

Strategies included:

• Short waiting time to appointments (fewer than 14 days);
• Increased access to health care personnel via a dedicated hotline; and
• Pre- and post-appointment telephone counseling to increase understanding regarding the need for colposcopy and to reduce anxiety associated with the upcoming appointment.

To date one-third of the accrual goal has been reached. Interviewed participants have been appreciative and accepting of the intervention. Dr. Brooks’ pilot study will seek to determine if access, knowledge, motivation and encouragement are sufficient to increase adherence to appointments.

Delivery of Intensity-Modulated Radiation Therapy to Rural Areas of Maryland

Cedric Yu, DSc
Associate Professor,
Department of Radiation Oncology

In Maryland, there is a significant health disparity in the quality of cancer treatment accessible to rural versus urban Maryland populations. Dr. Cedric Yu is at the forefront of developing the latest radiation treatment techniques that will significantly benefit rural areas of Maryland. Through the utilization of well-established high-speed networking and computer information technology, Dr. Yu has developed a means to provide state- of-the-art radiation therapy to cancer patients in Maryland’s rural areas without patients having to commute to the city.

Dr. Yu and his colleagues in the Department of Radiation Oncology have also patented a technology called Direct Aperture Optimization (DAO) Intensity Modulated Radiation Therapy (IMRT) designed to maintain the simplicity and efficiency of conventional radiation therapy, while providing the dosimetric benefits offered by IMRT. The DAO technology has been licensed by Prowess, Inc., and the commercial treatment planning system developed based on this technology has received FDA clearance.

The University of Maryland School of Medicine is among the first institutions in the world to offer IMRT to cancer patients and is the leading institution in the U.S. in developing innovative techniques for cancer therapy.