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Eur J Cancer. 2015 Nov;51(16):2375-85. doi: 10.1016/j.ejca.2015.07.006. Epub 2015 Aug 18.

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.

Author information

1
Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium.
2
Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany.
3
Dalla Lana School of Public Health, University of Toronto, 155 College Street , 6th Floor, Toronto, Ontario M5T3M7, Canada.
4
Department of Pathology, VU University medical center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
5
Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium. Electronic address: Marc.arbyn@wiv-isp.be.

Abstract

INTRODUCTION:

Population coverage for cervical cancer screening is an important determinant explaining differences in the incidence of cervical cancer between countries. Offering devices for self-sampling has the potential to increase participation of hard-to-reach women.

METHODS:

A systematic review and meta-analysis were performed to evaluate the participation after an invitation including a self-sampling device (self-sampling arm) versus an invitation to have a sample taken by a health professional (control arm), sent to under-screened women.

RESULTS:

Sixteen randomised studies were found eligible. In an intention-to-treat analysis, the pooled participation in the self-sampling arm was 23.6% (95% confidence interval (CI)=20.2-27.3%), when self-sampling kits were sent by mail to all women, versus 10.3% (95% CI=6.2-15.2%) in the control arm (participation difference: 12.6% [95% CI=9.3-15.9]). When women had to opt-in to receive the self-sampling device, as used in three studies, the pooled participation was not higher in the self-sampling compared to the control arm (participation difference: 0.2% [95% CI=-4.5-4.9%]).

CONCLUSION:

An increased participation was observed in the self-sampling arm compared to the control arm, if self-sampling kits were sent directly to women at their home address. However, the size of the effect varied substantially among studies. Since participation was similar in both arms when women had to opt-in, future studies are warranted to discern opt-in scenarios that are most acceptable to women.

KEYWORDS:

Cervical cancer; HPV; Meta-analysis; Randomised trial; Screening attendance; Self-sampling

PMID:
26296294
DOI:
10.1016/j.ejca.2015.07.006
[Indexed for MEDLINE]

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