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J Clin Virol. 2013 Sep;58(1):155-60. doi: 10.1016/j.jcv.2013.06.029. Epub 2013 Jul 15.

Comparison of use of vaginal HPV self-sampling and offering flexible appointments as strategies to reach long-term non-attending women in organized cervical screening.

Author information

1
Department of Obstetrics and Gynaecology, Skane University Hospital, Lund University, Lund, Sweden. Lotten.Darlin@med.lu.se

Abstract

BACKGROUND:

Many cervical cancers occur among women who have not attended cervical screening. Strategies to reach non-attending women may improve the effectiveness of cervical screening programmes.

OBJECTIVE:

To compare the responses among long-term non-attending women to either (i) HPV-testing of a self-collected vaginal sample, or (ii) cytological screening with a flexible no-fee appointment for sampling at an outpatient clinic.

STUDY DESIGN:

Among the 242,000 women aged 32-65 years in Southern Sweden, we identified 28,635 women who had not had any cervical smears taken for >9 years. We randomized 1000 women to invitation to HPV self-sampling, and 500 women to flexible outpatient clinic appointments. Responding women received a questionnaire about their reasons for previous non-attendance.

RESULTS:

The response rate to HPV self-sampling was three times higher than the flexible outpatient clinic invitations (147/1000 women (14.7%) compared to 21/500 (4.2%) p<0.0001). High-risk (hr)-HPV was found in 10/147 self-sampled women (6.9%). 7/10 hr-HPV-positive women attended colposcopy, but no HSIL was found. Among the clinic-sampled women, 2/21 had hr-HPV and 1/21 had HSIL. Reasons for not attending were "uncomfortable with vaginal examination", "feel healthy", "lack of time" and "experience of unfriendly health workers".

CONCLUSIONS:

Although the response rate was low for both interventions, the invitation to vaginal HPV self-sampling was more effective for increasing the coverage of the screening programme. The fact that "uncomfortable with vaginal examination" was the most common reason for non-attending suggests that self-sampling could be further explored as a strategy to increase the coverage of cervical screening programmes.

KEYWORDS:

Cytology; HPV testing; Non-attendance; Screening; Self-collected vaginal smear; Vaginal smear

PMID:
23867008
DOI:
10.1016/j.jcv.2013.06.029
[Indexed for MEDLINE]

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