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J Womens Health (Larchmt). 2019 Mar 15. doi: 10.1089/jwh.2018.7141. [Epub ahead of print]

Predictors of Cervical Cancer Screening Among Infrequently Screened Women Completing Human Papillomavirus Self-Collection: My Body My Test-1.

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1 Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
2 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
3 Department of Biological Sciences, Meredith College, Raleigh, North Carolina.
4 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
5 Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina.
6 American Sexual Health Association, Research Triangle Park, North Carolina.
7 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.



Approximately one-half of cervical cancer cases in the United States occur in underscreened or never-screened women. We examined predictors to completing Papanicolaou (Pap) testing and whether a positive human papillomavirus (HPV) self-collection result affects Pap testing adherence among underscreened women.


Low-income women aged 30-65 years who reported no Pap testing in ≥4 years were recruited in North Carolina. Knowledge, attitudes, and barriers regarding cervical cancer and Pap testing were assessed by telephone questionnaires. We mailed self-collection kits for HPV testing and provided information regarding where to obtain affordable Pap testing. Participants received $45 for completing all activities. We used multivariable logistic regression to assess the predictors of longer reported time since last Pap (≥10 vs. 4-9 years) and of completion of Pap testing following study enrollment (follow-up Pap).


Participants (n = 230) were primarily black (55%), uninsured (64%), and with ≤high school education (59%). Cost and finding an affordable clinic were the most commonly reported barriers to screening. White women and those with ≤high school education reported longer intervals since last Pap test. Half of the participants reported completing a follow-up Pap test (55%). Women with a positive HPV self-collection were five times more likely to report completing a follow-up Pap test than those with negative self-collection (odds ratio = 5.1, 95% confidence interval 1.4-25.7).


Improving awareness of resources for affordable screening could increase cervical cancer screening in underserved women. Home-based HPV self-collection represents an opportunity to re-engage infrequently screened women into preventive screening services.


barriers; cervical cancer screening; human papillomavirus; self-collection; underscreened


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