Self-Sampling for Human Papillomavirus Testing among Non-Attenders Increases Attendance to the Norwegian Cervical Cancer Screening Programme

Abstract

Increasing attendance to screening offers the best potential for improving the effectiveness of well-established cervical cancer screening programs. Self-sampling at home for human papillomavirus (HPV) testing as an alternative to a clinical sampling can be a useful policy to increase attendance. To determine whether self-sampling improves screening attendance for women who do not regularly attend the Norwegian Cervical Cancer Screening Programme (NCCSP), 800 women aged 25–69 years in the Oslo area who were due to receive a 2nd reminder to attend regular screening were randomly selected and invited to be part of the intervention group. Women in this group received one of two self-sampling devices, Evalyn Brush or Delphi Screener. To attend screening, women in the intervention group had the option of using the self-sampling device (self-sampling subgroup) or visiting their physician for a cervical smear. Self-sampled specimens were split and analyzed for the presence of high-risk (hr) HPV by the CLART® HPV2 test and the digene® Hybrid Capture (HC)2 test. The control group consisted of 2593 women who received a 2nd reminder letter according to the current guidelines of the NCCSP. The attendance rates were 33.4% in the intervention group and 23.2% in the control group, with similar attendance rates for both self-sampling devices. Women in the self-sampling subgroup responded favorably to both self-sampling devices and cited not remembering receiving a call for screening as the most dominant reason for previous non-attendance. Thirty-two of 34 (94.1%) hrHPV-positive women in the self-sampling subgroup attended follow-up. In conclusion, self-sampling increased attendance rates and was feasible and well received. This study lends further support to the proposal that self-sampling may be a valuable alternative for increasing cervical cancer screening coverage in Norway.

Advancing the evaluation of cervical cancer screening: development and application of a longitudinal adherence metric

“…Home-based testing for HPV has shown promising potential to increase screening participation (26,27), yet the cost-effectiveness of self-sampling policies relies on targeting the most under-screened women and those at highest risk of developing CC (28,29). As such, understanding women's screening history and its association with cancer outcomes is essential.…”

Human Papillomavirus Research: Where Should We Place Our Bets?

“…Self-sampling based on the dissemination of postal testing kits, which contain swabs for the self-collection of exfoliated vaginal samples, has been introduced in certain settings, including at the programme level [18, 19]. Self-sampling has largely been directed to women who default from regular screening invitations [20, 21].…”

Self-Sampling for Cervical Cancer Screening: Empowering Women to Lead a Paradigm Change in Cancer Control

“…Self-sampling can change this state of affairs by enabling screening programs to reach marginalized women and ultimately increase attendance. There is increasing evidence to that effect [11][12][13][14][15] . It stands to reason to assume that women who do not benefit from screening are also less likely to be reached by hpv vaccination programs 16 , which augments the disparity in health promotion that self-sampling can help reduce or eliminate.…”