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Br J Cancer. 2014 Nov 25;111(11):2187-96. doi: 10.1038/bjc.2014.510. Epub 2014 Sep 23.

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

Author information

1
1] INSERM, U1153, Paris, France [2] Cancer Screening Department, CHRU de Tours, Tours 37000, France.
2
Cancer Screening Department, CHRU de Tours, Tours 37000, France.
3
1] Department of Bacteriology and Virology, CHRU de Tours, Tours 37000, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] INSERM U966, Tours 37000, France.
4
Medico-Economic Evaluation Unit, CHRU de Tours, Tours 37000, France.
5
1] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [2] Department of Gynaecology and Obstetrics, CHRU de Tours, Tours 37000, France.
6
Virology Laboratory, Inter-Regional Health Institute, Tours 37000, France.
7
1] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [2] Medico-Economic Evaluation Unit, CHRU de Tours, Tours 37000, France [3] Université François-Rabelais, Équipe émergente de recherche Éducation, Éthique, Santé, Tours, France.
8
1] INSERM, U1153, Paris, France [2] Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours 37000, France [3] CHRU de Tours, INSERM CIC1415, Tours 37000, France.

Abstract

BACKGROUND:

Cervical cancer screening coverage remains insufficient in most countries. Our objective was to assess whether in-home vaginal self-sampling with a dry swab for high-risk human papillomavirus (HR-HPV) testing is effective and cost-effective in increasing participation in cervical cancer screening.

METHODS:

In March 2012, 6000 unscreened women aged 30-65 years, living in a French region covered by a screening programme, who had not responded to an initial invitation to have a Pap smear were equally randomised to three groups: 'no intervention'; 'recall', women received a letter to have a Pap smear; and 'self-sampling', women received a self-sampling kit to return to a centralised virology laboratory for PCR-based HPV testing.

RESULTS:

Participation was higher in the 'self-sampling' than in the 'no intervention' group (22.5% vs 9.9%, P<0.0001; OR 2.64) and 'recall' group (11.7%, P<0.0001; OR 2.20). In the 'self-sampling' group, 320 used the self-sampling kit; for 44 of these women with positive HR-HPV test results, 40 had the recommended triage Pap smear. The ICER per extra screened woman was 77.8[euro ] and 63.2[euro ] for the 'recall' and 'self-sampling' groups, respectively, relative to the 'no intervention' group.

CONCLUSIONS:

Offering an in-home, return-mail kit for vaginal self-sampling with a dry swab is more effective and cost-effective than a recall letter in increasing participation in cervical cancer screening.

PMID:
25247320
PMCID:
PMC4260034
DOI:
10.1038/bjc.2014.510
[Indexed for MEDLINE]
Free PMC Article

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