Abstract
Simple SummaryReunion Island is a French overseas department where cervical cancer is 2 to 3 times more prevalent than in mainland France. Screening rates are lower, especially among women from disadvantaged socioeconomic backgrounds. The RESISTE research program aims to assess whether sending a self-sampling kit to women’s homes could improve screening uptake. Prior to the implementation of this program, qualitative research was conducted with women from various disadvantaged backgrounds, as well as health professionals, to measure knowledge levels, identify barriers and triggers to screening, and assess the acceptability of a home-based self-sampling methodology. The results demonstrate the interest of women and health professionals in this screening method, while also highlighting the need to (1) reassure women regarding usage and quality and (2) provide support and outreach.Cervical cancer incidence and mortality rates are 2 to 3 times higher in the overseas department of Reunion compared with mainland France. RESISTE’s cluster-randomized controlled trial aims to test the effectiveness of home-based self-sampling (HBSS) through a high-risk oncogenic papillomavirus test sent out by post to women who have not been screened in the past 3 years, despite having been invited to do so through a reminder letter. Prior to the trial, qualitative research was carried out to understand screening barriers and assess anticipated acceptability. Semi-structured interviews were conducted with 35 women and 20 healthcare providers. Providers consider HBSS a viable method in reaching women who tend not to visit a doctor regularly, or who are reluctant to undergo a smear pap, as well as those who are geographically isolated. They considered, however, that women would require support, and that outreach was necessary to ensure more socially isolated women participate. The majority of the women surveyed were in favour of HBSS. However, two-thirds voiced concerns regarding the test’s efficiency and their ability to perform the test correctly, without harming themselves. Based on these findings, recommendations were formulated to reassure women on usage and quality, and to help reach socially isolated women.
Highlights
Curable and preventable, cervical cancer (CC) is the third most common gynaecological cancer before the age of 45 [1]
The study sample was comprised of 35 women of various ages (10 aged 25 to 35, 17 aged 36 to 50, and 8 over 50), and divers social and economic backgrounds, cultural origins and life contexts, as encountered in Reunion Island
This study found that migrant women, women with housing issues, and those in prison had multiplied factors of social disadvantage and isolation
Summary
Curable and preventable, cervical cancer (CC) is the third most common gynaecological cancer before the age of 45 [1]. In 2020, cervical cancer ranked as the ninth most common cancer worldwide, and the fourth in women [2]. In France, 21% of cervical cancer cases are attributable to social disadvantage [3]. Of those affected by cervical cancer, women living in socio-economically deprived conditions are more likely to die from the disease [4]. The standardized mortality rate for cervical cancer is 4.8/100,000 women, two times higher than in Metropolitan France [5]. Since 2009, as part of the Organized Cervical Cancer Screening (OCCS) program, an invitation is sent out by post to women who have not undergone CC screening in the past 3 years [6]. The participation rate of women who receive such invitations remains low (23–24%) [7]. A 2017 survey of a representative sample of 1000 women showed the main determinants of non-adherence to OCCS to be lower socioeconomic status, a lack of knowledge about CC screening, low literacy rates, and immigration from other Indian Ocean territories [7]
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