Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: A systematic review and meta-analysis of randomised trials

Verdoodt, Freija; Jentschke, Matthias; Hillemanns, Peter; Racey, C. Sarai; Snijders, Peter J.F.; Arbyn, Marc

doi:10.1016/j.ejca.2015.07.006

Cited by 238 publications

(262 citation statements)

References 48 publications

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“…A recent systematic review and meta-analysis reported that hpv self-screening with home kits significantly improved pooled participation in cervical cancer screening by double, compared with invitations to attend cytology 29 . By shifting screening to a non-clinical setting, self-collection can improve access to screening 10 among women who face barriers to clinic-based screening, and it offers a patientcentred approach that may improve engagement with screening 30 .…”

Section: Using Hpv Self-collection To Reach Under-screened Womenmentioning

confidence: 99%

“…There are different approaches to offering self-collectionbased screening to non-attenders that have been tested in various countries 29 . The hpv-based screening program in the Netherlands is attempting to reach a higher number of non-attenders by using an opt-out approach in which self-collection kits are directly mailed to under-screened women, often after a reminder letter.…”

Section: Considerations For Implementationmentioning

confidence: 99%

“…Modelling has shown that this method will improve the effectiveness of a primary hpv screening-based program in a cost-effective manner, provided that sensitivity remains high and the program can sufficiently reach under-screened women 34 . A significant threat to this approach is that in practice, uptake rates have been highly variable (between 6.4% and 34%) 29 and there is significant waste and cost associated with unused kits 35 . In a research setting, large trials have used door-to-door recruitment, where community health workers offer sampling to eligible women at their homes, yielding participation rates higher than 90% 29 ; however, this is resource intensive and not feasible in many settings.…”

Section: Considerations For Implementationmentioning

confidence: 99%

“…A significant threat to this approach is that in practice, uptake rates have been highly variable (between 6.4% and 34%) 29 and there is significant waste and cost associated with unused kits 35 . In a research setting, large trials have used door-to-door recruitment, where community health workers offer sampling to eligible women at their homes, yielding participation rates higher than 90% 29 ; however, this is resource intensive and not feasible in many settings. In an opt-in approach, under-screened women are invited to request a kit to their homes, either by phone or through a digital system such as a website 26 .…”

Section: Considerations For Implementationmentioning

confidence: 99%

“…In an opt-in approach, under-screened women are invited to request a kit to their homes, either by phone or through a digital system such as a website 26 . This approach assumes that there are fewer wasted kits, but it could result in lower gains in population coverage, and in some studies, opt-in hpv screening did not demonstrate a significant improvement over invitation letters to cytology 29 . Alternative self-collection strategies may need to be evaluated to identify optimal approaches in different population settings.…”

Section: Considerations For Implementationmentioning

confidence: 99%

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Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

et al. 2018

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The success of cytology (Pap screening) programs is undeniable and has drastically reduced cervical cancer rates in high-income settings where it has been implemented 1 . However, cytology for primary cervical cancer screening has a number of limitations including poor sensitivity, a taxing demand on human and operational infrastructure, high health system costs, and limited uptake rates, leading researchers and policy-makers to question whether further gains in public health are possible using this approach 2 . Persistent infection with high-risk genotypes of human papillomavirus (hpv) is well established as the necessary cause for development of cervical cancer 3 . Research has shown a 30% improvement in sensitivity in detecting high-grade lesions, cervical squamous intraepithelial neoplasia (cin) grade 2 or greater (cin2+), can be achieved with high-risk hpv dna testing compared with cytology 4 . A negative hpv test confers two-fold greater reassurance against the development of cervical cancer over three years compared with a negative cytology test 2,5 . The Netherlands has recently transitioned from cytology to hpv testing for primary cervical cancer screening in their National program. Many organized screening programs intend to implement primary hpv screening 6-9 , including Australia, which will begin implementation in December 2017.A consistent barrier to cytology-based cervical cancer screening is non-attendance, which can be addressed through hpv testing using self-collected samples. Primary cervical cancer screening with hpv dna testing allows for the opportunity of self-collected samples, which is not possible with cytology. In hpv self-collection the sample is obtained vaginally by the woman herself, using a device such as a swab or brush. The swab is subsequently tested for high-risk strains of hpv in a laboratory. With this approach to screening, programs can mail self-collection kits directly to women who are overdue for screening as an alternative to a clinic-based visit. Self-collected cervical samples receiving hpv testing show comparable cin2+ sensitivity compared with clinician-collected samples tested with cytology and with hpv 10-12 . Self-collection has proven to be highly acceptable among women 13 .Huma n papillomav ir us self-collection has t he potential to overcome many of the personal and systemlevel barriers to screening that exist for cytology or other clinic-based screening methods. Some women, particularly those who have experienced abuse 14 or are otherwise marginalized, may find self-sampling preferable because of such things as cultural/religious embarrassment or discomfort associated with a pelvic exam 13,[15][16][17] . Time, transportation, inconvenient clinic hours, or not having a regular practitioner are also relevant factors associated with under-screening that can be mitigated through hpv self-collection using mailed samples 13,16,17 . However, there are psychosocial barriers to hpv screening, including women's lack of awareness and fears around hpv and cervical cancer...

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Section: Using Hpv Self-collection To Reach Under-screened Womenmentioning

confidence: 99%

Section: Considerations For Implementationmentioning

confidence: 99%

Section: Considerations For Implementationmentioning

confidence: 99%

Section: Considerations For Implementationmentioning

confidence: 99%

Section: Considerations For Implementationmentioning

confidence: 99%

See 3 more Smart Citations

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

et al. 2018

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Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening

et al. 2023

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ImportanceHuman papillomavirus (HPV) self-sampling addresses barriers to cervical cancer screening, and mailed self-sampling kits have been reported to increase screening uptake. International research suggests mailed kits are cost-effective in certain settings. However, the cost-effectiveness of mailing HPV self-sampling kits for increasing screening uptake has not been evaluated in the US.ObjectiveTo conduct an economic evaluation of a mailed HPV self-sampling intervention among underscreened women enrolled in an integrated US health care system.Design, Setting, and ParticipantsThis economic evaluation involved a cost-effectiveness analysis of results from a randomized clinical trial of 19 851 women aged 30 to 64 years enrolled in a health plan from Kaiser Permanente Washington (KPWA), a US-based integrated health care system. Women were identified through electronic medical records, and eligible participants were enrolled in a health plan for at least 3 years and 5 months, had a primary care clinician, had not received a Papanicolaou test for at least 3 years and 5 months, and had not received a hysterectomy. Enrollment occurred from February 25, 2014, to August 29, 2016, with follow-up through February 25, 2018. The current economic evaluation was conducted between August 2, 2021, and July 30, 2022. Intervention delivery costs were calculated from both the KPWA and Medicare perspectives and were based on either wellness visit or Papanicolaou test–only visit costs.InterventionParticipants in the control group received usual care, which comprised patient reminders and ad hoc outreach for screening. Participants in the intervention group received usual care plus a mailed HPV self-sampling kit.Main Outcome and MeasuresThe primary economic outcome was the incremental cost-effectiveness ratio (ICER) for increased screening uptake, defined as the incremental difference in cost (intervention group minus control group) divided by the difference in the number of participants completing screening (intervention group minus control group) within 6 months of randomization.ResultsAmong 19 851 women (mean [SD] age, 50.1 [9.5] years; 76.7% White), 9960 were randomized to the intervention group, and 9891 were randomized to the control group. Baseline ICERs ranged from $85.84 (95% CI, $85.68-$85.99) using KPWA wellness visits as the cost basis to $146.29 (95% CI, $146.20-$146.38) using Medicare Papanicolaou test–only visits as the cost source. Subgroups of participants aged 50 to 64 years and participants most recently overdue for screening achieved cost-effectiveness at lower levels of willingness to pay for an additional completed screening than other subgroups.Conclusions and RelevanceIn this economic evaluation, mailing HPV self-sampling kits to women overdue for cervical cancer screening was cost-effective for increased screening uptake relative to usual care. These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates among eligible women in US health care systems.

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Human papillomavirus (HPV) self-sampling to encourage the uptake of cervical screening

Shiraz,

Schiemer,

Staley

et al. 2023

Cochrane Database of Systematic Reviews

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Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: A systematic review and meta-analysis of randomised trials

Cited by 238 publications

References 48 publications

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening

Human papillomavirus (HPV) self-sampling to encourage the uptake of cervical screening

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