Abstract
Attendance in screening is an important determinant of cervical cancer. Previous experience on high-risk human papillomavirus (hrHPV) DNA testing on patient-obtained samples suggests a good effect among nonattendees of screening. We assessed the effects of self-sampling on attendance in the Finnish screening program. Nonattendees after the primary invitation in one municipality (Espoo) were randomized to receive either a self-sampling kit (2,397 women) or an extra invitation (6,302 women). One fourth (1,315 women) of reminder letter arm nonattendees also received a self-sampling kit as a third intervention. Main outcomes were increases in screening attendance and coverage. The adjusted relative risk for participation by self-sampling as a second intervention in comparison to a reminder letter arm was 1.21 (95% CI: 1.13-1.30). Total attendance increased from 65% to 76% by self-sampling and from 65% to 74% with a reminder letter. Combining the interventions (reminder letter and then self-sampling) increased total attendance from 63% to 78%. One fifth of the participants in all three groups increased screening coverage (previous Pap smear ≥5 years ago or never). Self-obtained samples were more often HPV positive than provider-obtained ones (participants after primary invitation and reminder letter), 12% to 13% versus 7%. Self-sampling is a feasible option in enhancing the attendance at organized screening, particularly as an addition to a reminder letter. If self-sampling is used as a third intervention after two written invitations, the overall attendance in Finland could most likely reach the desired 80% to 85%.
Highlights
Suboptimal attendance rates limit the effectiveness of the cervical cancer screening program
Total attendance increased from 63.3% to 72.7% by reminder letter and further to 78.1% by self-sampling (Fig. 2)
Results of high-risk human papillomavirus (hrHPV) analysis and histologic findings Of the returned self-taken samples considered adequate for analysis, HC2 test was positive in 81 of 663 (12.3%; 95% CI: 9.9–15.0) when self-sampling was used as a second intervention and in 31 of 239 (13.0%; 95% CI: 9.0– 17.9) when it was used as a third intervention (Table 4)
Summary
Suboptimal attendance rates limit the effectiveness of the cervical cancer screening program. In Finland, the overall attendance rate in the organized screening program is 70% and among women aged 30 to 35 only 50% to 60%; the desired 80% to 85% attendance nationwide is not fulfilled [5]. A possible new method to activate the current nonattendees of the program are screening tests in which the Authors' Affiliations: 1Mass Screening Registry, Finnish Cancer Registry, Helsinki; and 2Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland. Attendance in screening is an important determinant of cervical cancer. Previous experience on high-risk human papillomavirus (hrHPV) DNA testing on patient-obtained samples suggests a good effect among nonattendees of screening. We assessed the effects of self-sampling on attendance in the Finnish screening program
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