HPV self-sampling in cervical cancer screening: the effect of different invitation strategies in various socioeconomic groups - a randomized controlled trial

Abstract

BackgroundParticipation in cervical cancer screening varies by socioeconomic status. The aims were to assess if offering human papilloma virus (HPV) self-sampling kits has an effect on screening participation among various socioeconomic groups and to determine if two invitation strategies for offering self-sampling influence the participation rate equally.MethodsThe study was based on registry data that were applied to data from a randomized controlled trial (n=9,791) measuring how offering HPV self-sampling affected screening participation. The women received either 1) a self-sampling kit mailed directly to their homes (directly mailed group); 2) an invitation to order the kit (opt-in group); or 3) a standard second reminder to attend regular cytology screening (control group). The participation data were linked to registries containing socioeconomic information.ResultsWomen in the directly mailed group participated significantly more than women in the control group, regardless of their socioeconomic status, but the largest effects were observed in Western immigrants (participation difference [PD]=18.1%, 95% CI=10.2%–26.0%) and social welfare recipients (PD=15.2%, 95% CI=9.7%–20.6%). Compared with the control group, opt-in self-sampling only had an insignificant effect on participation among women who were immigrants, retired, or less educated. Western immigrants had a significantly higher increase in participation than native Danish women when kits were mailed directly compared with the opt-in strategy (PD=18.1%, 95% CI=10.2%–26.2% and PD=5.5%, 95% CI=2.9%–8.1%, respectively, P=0.01).ConclusionAll socioeconomic groups benefited from the directly mailed strategy in terms of higher screening participation, but Western immigrants and lower socioeconomic groups seemed to benefit the most. Immigrants and some lower socioeconomic groups only had insignificant benefits of opt-in self-sampling. The directly mailed strategy might be preferable to opt-in self-sampling because it ensures that ethnic minority groups obtain benefits of introducing HPV self-sampling in an organized cervical cancer screening program.Trial registrationCurrent Controlled Trials NCT02680262. Registered February 10, 2016.

Awareness of Young Japanese Women on HPV Self-Sampling Trial using Opt-in Method

“…On the other hand, receptivity by women who actually performed self-sampling is high in other countries [26], and about 90% of women who perform self-sampling also have a positive impression of the use of the self-sampling kits in our study. In addition, it is clarified that 97.4% of the subjects prefer self-sampling to sampling by a clinician and this is higher than (62.0%) in a survey performed by Winer et al [19],clarifying that young Japanese women strongly prefer self-sampling compared with women in other countries.…”

“…Hanley et al [23] mention that the opt-in method which confirmed the intention of wanting or not wanting to send self-sampling kits caused a low return ratio than with the directmailed/opt-out method. Tranberg et al [26] mention also that there were much more women conducting self-sampling in the direct-mailed/opt-out method than women that used the opt-in method (direct: 9.4%, opt-in: 8.3%). Therefore, our result has a higher value in this comparative study.…”

“…The incidence of CC excepted of carcinoma insitu (CIS) in 25-29 year old Japanese women was 3.0 (per 100,000 people) in 2016 [3],and the mortality of the women was 0.3 (per 100,000 people) in 2017 [4]. However, the rate of people attending CC screenings, a preventive measure, was 42.4% in 25-69 year old and 26.5% in [20][21][22][23][24][25][26][27][28][29] year old Japanese women in 2016, being markedly lower than those in Western countries, and similar to middle income country rates [5].…”

Self‐collection of samples for HPV testing to increase participation in cervical cancer screening by immigrant women: An integrative review

“…on subgroup-specific attitudes and beliefs about self-collection (De Alba et al, 2008;Forrest et al, 2004;Howard et al, 2009;Ilangovan et al, 2016;Lofters et al, 2017;Montealegre, Mullen, Jibaja-Weiss, Vargas Mendez, & Scheurer, 2015;Vahabi & Lofters, 2016;Virtanen et al, 2014) all the way through regional and national implementation with subgroup analysis for differences in uptake depending on delivery method (Kobetz et al, 2018;Tranberg et al, 2018). Three studies focused on CCS completion rates in the self-collection group versus standard clinic-based collection (Sewali et al, 2015;Virtanen et al, 2015;Virtanen, Anttila, Luostarinen, & Nieminen, 2011).…”

“…top three countries of origin: Syria 12.6%, Turkey 10.5%, Lebanon 7.9%; Tranberg et al, 2018). In the studies conducted in Finland using population-based screening registries, immigrants were distinguished only by the fact that their native language was not either Finnish or Swedish, the two official languages of the study country (Virtanen et al, 2011(Virtanen et al, , 2014(Virtanen et al, , 2015.…”