Comparison of use of vaginal HPV self-sampling and offering flexible appointments as strategies to reach long-term non-attending women in organized cervical screening

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• 作者：Lotten Darlin ; Christer Borgfeldt ; Ola Forslund ; Emir H¨¦nic ; Maria Hortlund ; Joakim Dillner ; P?ivi Kannisto
• 关键词：Screening ; Non-attendance ; HPV testing ; Vaginal smear ; Cytology ; Self-collected vaginal smear
• 刊名：Journal of Clinical Virology
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：58
• 期：1
• 页码：155-160
• 全文大小：1095 K

文摘

Background

Many cervical cancers occur among women who have not attended cervical screening. Strategies to reach non-attending women may improve the effectiveness of cervical screening programmes.

Objective

To compare the responses among long-term non-attending women to either (i) HPV-testing of a self-collected vaginal sample, or (ii) cytological screening with a flexible no-fee appointment for sampling at an outpatient clinic.

Study design

Among the 242,000 women aged 32-65 years in Southern Sweden, we identified 28,635 women who had not had any cervical smears taken for >9 years. We randomized 1000 women to invitation to HPV self-sampling, and 500 women to flexible outpatient clinic appointments. Responding women received a questionnaire about their reasons for previous non-attendance.

Results

The response rate to HPV self-sampling was three times higher than the flexible outpatient clinic invitations (147/1000 women (14.7 % ) compared to 21/500 (4.2 % ) p < 0.0001). High-risk (hr)-HPV was found in 10/147 self-sampled women (6.9 % ). 7/10 hr-HPV-positive women attended colposcopy, but no HSIL was found. Among the clinic-sampled women, 2/21 had hr-HPV and 1/21 had HSIL. Reasons for not attending were ¡°uncomfortable with vaginal examination¡±, ¡°feel healthy¡±, ¡°lack of time¡± and ¡°experience of unfriendly health workers¡±.

Conclusions

Although the response rate was low for both interventions, the invitation to vaginal HPV self-sampling was more effective for increasing the coverage of the screening programme. The fact that ¡°uncomfortable with vaginal examination¡± was the most common reason for non-attending suggests that self-sampling could be further explored as a strategy to increase the coverage of cervical screening programmes.