Improving cervical cancer screening attendance in Finland

Abstract

High attendance is essential to cervical cancer screening results. Attendance in the Finnish program is currently at 70%, but extensive opportunistic screening occurs beside the organized. A shift from opportunistic to organized screening is imperative to optimize the costs and impact of screening and minimize potential harms. We evaluated the effect of reminder letters (1st reminder) and self-sampling test (2nd reminder) on program attendance. The study population consisted of 31,053 screening invitees in 31 Finnish municipalities. 8,284 non-attendees after one invitation received a reminder letter and 4,536 further non-attendees were offered a self-sampling option. Socioeconomic factors related to participation were clarified by combining screening data to data from Statistics Finland. Reminder letters increased participation from 72.6% (95% CI 72.1, 73.1) to 79.2% (95% CI 78.8, 79.7) and self-sampling further to 82.2% (95% CI 81.8, 82.7). Reminder letters with scheduled appointments resulted in higher increase than open invitations (10 vs. 6%). Screening of original non-attendees increased the yield of CIN31 lesions by 24%. Non-attendance was associated with young age, immigrant background, lower education level and having never been married. We showed that a total attendance of well over 80% can be achieved within an organized program when the invitational protocol is carefully arranged.Good coverage amongst those at risk and high attendance within the cervical cancer screening program are of paramount importance to results. In Finland, a substantial proportion of cancer incidence and especially mortality among women in screening ages 30-60 years is seen among nonattendees. 1,2 Attendance in the program is currently 70% with a slightly decreasing trend (www.cancerregistry.fi).In addition to personal invitations to screening, prebooked appointments in invitation letters and reminders sent to non-attendees increase screening attendance. 3-12 Selfsampling for high risk human papillomavirus (hrHPV) DNA testing helps to further increase attendance among women who are not reached by the routine screening program. [11][12][13][14][15][16][17][18][19] The ability (relative sensitivity) to detect moderate cervical intraepithelial neoplasias or worse (CIN21) of hrHPVtesting on self-taken samples has been shown to be somewhat lower than that of hrHPV-testing on clinician-based samples, but similar or even more sensitive to a Pap-smear, depending on the cytological threshold. 20 The main aim of this study was to study the effect of reminder letters (1st reminder) and self-sampling tests (2nd reminder) as means to increase attendance within the routine cervical cancer screening programme in a wide setting of Finnish municipalities. Screening results among the attendees and original non-attendees were also explored.We further studied the socioeconomic characteristics of nonparticipants to routine screening to find groups that should be in the focus when planning interventions to increase attendance. Material and MethodsIn...

Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study

“…An additional analysis showed that the participation rate in screening for cervical cancer among Korean women aged 15–80 was 58.6%. This is extremely low compared with those observed in other developed countries; for example, the screening rate is approximately 82.9% in the USA,21 80% in the UK22 and 70% in Finland 23. Other studies from Asia suggest that participation in screening for cervical cancer is low (42.1% in Japan, 2013, 52.9% in Taiwan, 2006) 24…”

Factors associated with cervical cancer screening participation among immigrants of Russian, Somali and Kurdish origin: a population-based study in Finland

“…The number of immigrants including females in Finland has increased in recent years [27]. Previous studies in Finland revealed lower participation rates for cervical cancer screening among immigrants compared with the general Finnish population [28]. To date, however, the reasons for this low participation have been unexplored.…”

Impact of scheduled appointments on cervical screening participation in Norway: a randomised intervention

“…The effects of the intervention in our study are similar or somewhat larger than these previous findings. More recently, Finnish municipalities using scheduled appointments were reported to achieve a twofold participation after the second reminder compared with municipalities using open reminders 13. Different settings and time periods may influence the impact of the intervention.…”

“…Significant pooled effects on participation (RR 1.5) of scheduled appointments in cervical cancer screening were reported in a systematic review covering three randomised studies 9. More recently, a Finnish report compared municipalities using scheduled and open second reminders and found a twofold difference in participation 13. Other screening programmes have also benefited from scheduled appointments; a non-randomised study from the UK breast cancer screening programme reported participation rates almost three times higher among women receiving timed second reminders 14…”