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BMC Cancer. 2018 Mar 9;18(1):273. doi: 10.1186/s12885-018-4165-4.

Preventing cervical cancer using HPV self-sampling: direct mailing of test-kits increases screening participation more than timely opt-in procedures - a randomized controlled trial.

Author information

1
Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark. mettrani@rm.dk.
2
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark. mettrani@rm.dk.
3
Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
4
Department of Obstetrics and Gynecology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
5
Department of Clinical Medicine, University of Southern Denmark, J.B. Winslows Vej 25, 5000, Odense C, Denmark.
6
Statens Serum Institut, 2300, Copenhagen S, Artillerivej 5, Denmark.
7
Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark.
8
Department of Pathology, Randers Regional Hospital, Østervangsvej 48, 8930, Randers, NØ, Denmark.
9
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.

Abstract

BACKGROUND:

Cervical cancer screening participation remains insufficient in most countries. Our aim was to evaluate whether offering a HPV self-sampling kit, either mailed directly to the woman's home or using timely opt-in procedures for ordering the kit, increased screening participation compared with a standard second reminder.

METHODS:

In this randomized, controlled effectiveness trial, 9791 Danish women aged 30-64 who were due to receive the second reminder were equally randomized to either: 1) direct mailing of a second reminder and a self-sampling kit (directly mailed group); 2) mailing of a second reminder that offered a self-sampling kit to be ordered by e-mail, text message, phone, or webpage (opt-in group); or 3) mailing of a second reminder to attend regular cytology screening (control group). In an intention-to-treat analysis, we estimated the participation rate at 180 days post intervention, by returning a self-sample or attending regular cytology screening. We calculated the proportion of women with a positive HPV self-sample who attended for cervical cytology triage at the general practitioner within 90 days.

RESULTS:

Participation was significantly higher in the directly mailed group (38.0%) and in the opt-in group (30.9%) than in the control group (25.2%) (participation difference (PD): 12.8%, 95% CI: 10.6-15.0% and PD: 5.7%, 95% CI: 3.5-7.9%, respectively). Within 90 days, 107 women (90.7%, 95% CI: 83.9-95.3%) with a HPV-positive self-sample attended follow-up.

CONCLUSIONS:

Offering the opportunity of HPV self-sampling as an alternative to regular cytology screening increased participation; the direct mailing strategy was the most effective invitation strategy. A high compliance with follow-up was seen.

TRIAL REGISTRATION:

Current Controlled Trials NCT02680262 . Registered 10 February 2016.

KEYWORDS:

Cancer prevention; Cervical cancer screening; Human papillomavirus testing; Screening participation; Self-sampling

PMID:
29523108
PMCID:
PMC5845195
DOI:
10.1186/s12885-018-4165-4
[Indexed for MEDLINE]
Free PMC Article

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