Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment: A Randomized Clinical Trial

Abstract

(Abstracted from JAMA Network Open 2019;2(11):e1914729) Greater than 50% of the 12,000 cases of cervical cancer diagnosed annually in the United States are in underscreened women. The US Preventative Task Force issued updated cervical cancer screening guidelines in 2018, suggesting the addition of primary human papillomavirus (HPV)–only screening to Papanicolaou testing alone and Papanicolaou and HPV cotesting for women aged 30 to 65 years.

The future of cancer screening after COVID‐19 may be at home

“…32,33 Home self-screening can be taught to and performed by patients. 34,35 Home screening can be integrated into the primary care provider workflow 36,37 for effective screening follow-up that is critical to the earlier detection of cancer, hence to reducing morbidity and mortality. Over time, as clinically relevant biomarkers emerge for the early detection of breast cancer, 38 these tests too may be conducted at home.…”

“…Home self‐screening can be taught to and performed by patients 34,35 . Home screening can be integrated into the primary care provider workflow 36,37 for effective screening follow‐up that is critical to the earlier detection of cancer, hence to reducing morbidity and mortality.…”

Performance and acceptability of self-collected human papillomavirus testing among women living with HIV

“…This indicates that the self-collected HPV testing strategy may be able to increase cervical cancer screening, if the purpose of HPV testing is made clear to patients. For example, one of the largest randomized clinical trials in the US of home HPV testing reported only 12% of participants returned the home HPV test kit, and there was no difference in detection of precancerous lesions compared to usual care (Winer et al, 2019). The poor kit return in this trial might be explained by the patients' lack of knowledge regarding the superior performance of HPV testing, the requirement to still attend the clinic for usual care, or the awareness that the results could not replace usual care screening methods (Moss et al, 2019).…”

Intercepting Endometrial Cancer: Opportunities to Expand Access Using New Technology

“…The current lack of patient engagement in promising prevention tests was clear in a randomized clinical trial of mailed human papillomavirus test kits compared with usual care reminders. Screening uptake improved modestly: 26.3% in the mailed collection kit compared with 17.4% in the usual care group (23).…”