Vaginal self-sampling is a cost-effective way to increase participation in a cervical cancer screening programme: a randomised trial

Objective The purpose of this study is to assess the acceptability and intention to use cervico-vaginal self-sampling for hrHPV infection after receiving an educational intervention among the predominantly Hispanic population residing along the U.S.-Mexico border. Methods Women received an educational intervention about cervical cancer prevention through screening with conventional cytology and with self-sampling for hrHPV. After the educational intervention women performed the self-sampling test. Women’s attitudes towards the self-sampling test and cervical cytology were assessed and compared. Results A total of 110 women aged 30 – 65 years completed the study. The mean age of the population was 48 years (SD 9.3); most (87%) self-identified as being Hispanic and half were born in Mexico; 16% had not had cervical cytology done in 3 years. Self-sampling was more acceptable than cervical cytology; acceptability scores were 25.0(SD 2.9) and 22.7(SD 3.0) respectively, with the maximum possible score being 28. (p <.001). A large proportion of women (42.7%) preferred both tests equally. We found high intention to use and recommend self-sampling. Contrary to previous studies, there were no differences between cervical cytology and self-sampling regarding women’s concerns about performing the test well and the accuracy of the test, which we attribute to the educational intervention. Conclusion The high acceptability of self-sampling after participants received education about the test and the reported intention to use it if made available adds to the evidence on the feasibility of integrating self-testing within cervical cancer screening guidelines.

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“…5 Furthermore, self-sampling has the potential of reducing cost when used at home with a return-mail kit. 27 …”

Section: Discussionmentioning

confidence: 99%

Women's Attitudes Toward Cervicovaginal Self-Sampling for High-Risk HPV Infection on the US-Mexico Border

Peñaranda¹,

Molokwu

Flores

et al. 2015

Journal of Lower Genital Tract Disease

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“…17 A recent study found that an in-home return mail kit sent to women aged 30-65 who had not previously responded to a call to screening was significantly more effective than a recall letter in eliciting a response. 18 Uptake of follow-up cervical screening among the women with a positive HPV result was 91%. This suggests that posting kits to older women could reduce the risk for those who have not taken full advantage of the call-recall system or at least enable any cancer to be diagnosed at an earlier stage with the potential to increase healthy years of life expectancy.…”

Section: Case For Screening Older Women and Some Possible Solutionsmentioning

confidence: 99%

Cervical cancer is not just a young woman's disease

Sherman

Castañón

Moss

et al. 2015

BMJ

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colleagues argue that the upper age limit for cervical screening needs revisiting and call for awareness campaigns to target older as well as younger women Cervical screening programmes in many countries stop at around the age of 65 and much of the focus is often on younger women. For example, recent media campaigns in England and Wales have centred on lowering the age at first screening. Comparatively little attention has been given to older women despite the fact that they account for about a fifth of cases each year and half of deaths.1 2 Of the 3121 women diagnosed on average each year between 2009 and 2011 in the UK, only 64 were younger than 25 compared with 616 who were older than 65.1 As the population ages, this number of older women affected is set to increase. We argue that screening programmes should reflect this. Age distribution of casesThe raw statistics conceal the full impact of cervical cancer on older women. Although the absolute figures decrease with increasing age, when the rate of new cases per 100 000 women is considered, a second peak in diagnoses after the age of 65 becomes apparent (table⇓). The case rate gradually decreases from 19.7 new diagnoses per 100 000 women aged 30-34 to a low of 8.6/100 000 women aged 65-69, but then rises again, reaching 12.5/100 000 in women aged 80-84. Furthermore, mortality data for the UK from 2010-12 show only seven deaths a year from cervical cancer in women younger than 25 but 449 deaths in women older than 65-nearly half of the total average deaths from cervical cancer in any year. Although recent research by Castanon and colleagues suggests that women aged 65 who have had regular screening with negative results have a relatively low 20 year risk of 8/10 000 women, it also reports that for those women who have not been screened between the ages of 50 and 64, the 20 year risk rises to 49/10 000 women.3 This raises several issues. Screening uptake falls in older womenThe proportion of women in England in 2013 who had been screened in the past five years dropped with age, from 82.4% of 50-54 year olds to 75.9% of 55-59 year olds and 72.7% of 60-64 year olds. 4 These numbers are set to fall further because uptake is decreasing across all age groups. More than 25% of older women would therefore not be in the low risk group defined by Castanon and colleagues. 3 The fall in uptake suggests that as women age they perceive cervical screening to be less important. This is supported by Waller and colleagues, 5 who found that only 12% of 55-64 year old women cited not attending screening as a risk factor for cervical cancer. In addition, only 2.1% of participants across their whole sample identified older age as a risk factor, suggesting that it is perceived as being a younger woman's disease. This interpretation is strengthened by the fact that the age related decline in screening uptake seems to be specific to cervical screening. The 2010-11 breast cancer screening data show that 70.7% of invited women aged 45-49 attended breast screening, increasing to 74.9% i...

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“…29 In other countries that lack such comprehensive screening programs, opportunistic approaches using HPV self-sampling have also led to increased rates of screening among hard-toreach populations. 30,31 In the United States, our team is currently finalizing a randomized study testing HPV self-sampling among minority women lacking adequate screening from community-based nonclinical settings. 32 However, given our experience in using this approach in community-based samples and proven success in other clinical settings in other countries, we hypothesized that HPV self-sampling may be a viable strategy for cervical cancer screening in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Acceptability and Feasibility of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening

Ilangovan

Kobetz

Koru‐Sengul

et al. 2016

Journal of Women's Health

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Vaginal self-sampling is a cost-effective way to increase participation in a cervical cancer screening programme: a randomised trial

Cited by 80 publications

References 38 publications

Women's Attitudes Toward Cervicovaginal Self-Sampling for High-Risk HPV Infection on the US-Mexico Border

Women's Attitudes Toward Cervicovaginal Self-Sampling for High-Risk HPV Infection on the US-Mexico Border

Cervical cancer is not just a young woman's disease

Acceptability and Feasibility of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening

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