Self-sample HPV Tests As an Intervention for Nonattendees of Cervical Cancer Screening in Finland: a Randomized Trial

Abstract

Background: Attendance in screening is an important determinant of cervical cancer. Previous experience on high-risk human papillomavirus (hrHPV) DNA testing on patient-obtained samples suggests a good effect among nonattendees of screening. We assessed the effects of self-sampling on attendance in the Finnish screening program.Methods: Nonattendees after the primary invitation in one municipality (Espoo) were randomized to receive either a self-sampling kit (2,397 women) or an extra invitation (6,302 women). One fourth (1,315 women) of reminder letter arm nonattendees also received a self-sampling kit as a third intervention. Main outcomes were increases in screening attendance and coverage.Results: The adjusted relative risk for participation by self-sampling as a second intervention in comparison to a reminder letter arm was 1.21 (95% CI: 1.13-1.30). Total attendance increased from 65% to 76% by selfsampling and from 65% to 74% with a reminder letter. Combining the interventions (reminder letter and then self-sampling) increased total attendance from 63% to 78%. One fifth of the participants in all three groups increased screening coverage (previous Pap smear !5 years ago or never). Self-obtained samples were more often HPV positive than provider-obtained ones (participants after primary invitation and reminder letter), 12% to 13% versus 7%.Conclusions: Self-sampling is a feasible option in enhancing the attendance at organized screening, particularly as an addition to a reminder letter.Impact: If self-sampling is used as a third intervention after two written invitations, the overall attendance in Finland could most likely reach the desired 80% to 85%. Cancer Epidemiol Biomarkers Prev; 20(9); 1960-9. Ó2011 AACR.

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

“…In settings with established screening programs, hpv self-collection is recommended to complement, not replace, existing programs, as an approach to reach under-served women. Research has shown good attendance to follow-up with a health care provider among women who screen hpvpositive with self-collection 37 , suggesting self-collection could potentially act as a re-entry point for women into the screening program or health care system. However, for marginalized women or women who lack access, the followup necessary for an hpv-positive result, which usually takes place in a clinic setting, could be a barrier, and these women are at higher risk for developing cervical cancer 35 .…”

Dry self-sampling versus provider-sampling of cervicovaginal specimens for human papillomavirus detection in the Inuit population of Nunavik, Quebec

“…Additionally, self-sampling has the potential to increase the number of women screened for cervical cancer by increasing the participation of screening non-responders. 13,14 As selfsampling is a less invasive method, it may be appealing to women who fear speculum examination conducted by a health provider because of previous abuse, 15 feelings of embarrassment, 16 perceived inconvenience, 17 and cultural and religious reasons. 18,19 The Quebec Inuit population, who have a higher cervical cancer incidence and mortality rate than the general population of Quebec, 20 could benefit from a screening programme that incorporates HPV testing of self-collected samples.…”

Self-sampling for HPV to enhance uptake of cervical cancer screening: Has the time come in Canada?

“…Participation was significantly higher among women who received the self-sampling kit (31.5%, 95% confidence interval [CI] 29.7%-33.4% v. 25.9%, 95% CI 24.8%-27.0%). 10 Loss to follow-up after a positive HPV result was 13.4%. Self-sampling also appeared to prompt immigrant women (who had lower participation rates) more efficiently than the reminder letter.…”

“…As part of a randomized trial conducted within the context of the country's routine cervical cancer screening program, 8700 women in the Finnish Cancer Registry who did not participate in screening after their first invitation were randomly assigned to receive a self-sampling kit or a reminder letter. 10 Women who self-sampled and had a positive result were invited for a follow-up Pap test (age < 40 yr) or were referred directly for colposcopy (age ≥ 40 yr). Participation was significantly higher among women who received the self-sampling kit (31.5%, 95% confidence interval [CI] 29.7%-33.4% v. 25.9%, 95% CI 24.8%-27.0%).…”