The authors declare that they have no competing interests.
PD, MG, SR, LD, DF, AL, MT-Y, WG, MR, GM, and AP participated in the conception and design of the project. PD, MG, AP, JF and MP were involved in analysis and interpretation. PD, MG and JF drafted the article, and all authors provided revisions. All authors approved of the final version of the article.
Cervical cancer is highly preventable and treatable if detected early through regular screening. Women in the Canadian province of Newfoundland & Labrador have relatively low rates of cervical cancer screening, with rates of around 40 % between 2007 and 2009. Persistent infection with oncogenic human papillomavirus (HPV) is a necessary cause for the development of cervical cancer, and HPV testing, including self-sampling, has been suggested as an alternative method of cervical cancer screening that may alleviate some barriers to screening. Our objective was to determine whether offering self-collected HPV testing screening increased cervical cancer screening rates in rural communities.
During the 2-year study, three community-based cohorts were assigned to receive either i) a cervical cancer education campaign with the option of HPV testing; ii) an educational campaign alone; iii) or no intervention. Self-collection kits were offered to eligible women at family medicine clinics and community centres, and participants were surveyed to determine their acceptance of the HPV self-collection kit. Paired proportions testing for before-after studies was used to determine differences in screening rates from baseline, and Chi Square analysis of three dimensional 2 × 2 × 2 tables compared the change between communities.
Cervical cancer screening increased by 15.2 % (p < 0.001) to 67.4 % in the community where self-collection was available, versus a 2.9 % increase (p = 0.07) in the community that received educational campaigns and 8.5 % in the community with no intervention (p = 0.193). The difference in change in rates was statistically significant between communities A and B (p < 0.001) but not between communities A and C (p = 0.193). The response rate was low, with only 9.5 % (168/1760) of eligible women opting to self-collect for HPV testing. Of the women who completed self-collection, 15.5 % (26) had not had a Pap smear in the last 3 years, and 88.7 % reported that they were somewhat or very satisfied with self-collection.
Offering self-collected HPV testing increased the cervical cancer screening rate in a rural NL community. Women who completed self-collection had generally positive feelings about the experience. Offering HPV self-collection may increase screening compliance, particularly among women who do not present for routine Pap smears.
Racey CS, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta-analysis. Can J Publ Health. 2013;104(2):e159–66.
Lazcano-Ponce E, Tibor Lorincz A, Cruz-Valdez A, Salmeron J, Uribe P, Velasco-Mondragon E, et al. Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): a community-based randomised controlled trial. Lancet. 2011;378(9806):1868–73. CrossRefPubMed
Mayrand MH, Duarte-Franco E, Coutlée F, Rodrigues I, Walter SD, Ratnam S, et al. Randomized controlled trial of human papillomavirus testing versus Pap cytology in the primary screening for cervical cancer precursors: design, methods and preliminary accrual results of the Canadian cervical cancer screening trial (CCCaST). Int J Cancer. 2006;119(3):615–23. CrossRefPubMed
Iqidbashian S, Boveri S, Spolti N, Radice D, Sandri MT, Sideri M. Self-collected human papillomavirus testing acceptability: comparison of two self-sampling modalities. J Womens Health (Larchmt). 2011;20(3):397–402. CrossRef
Abraham J, Stenger M. Cobas HPV test for first-line screening for cervical cancer. J Commun Support Oncol. 2014;12(5):156–7. CrossRef
Levi JE, Longatto-Filho A, Eluf-Neto J, Rodrigues CL, Oliveira CM, Carloni AC, et al. Evaluation of HPV molecular tests in primary screening for cervical cancer in Brazil. OJOG. 2014;4(8):470–8. CrossRef
Sabesan S, Piliouras P. Disparity in cancer survival between urban and rural patients – how can clinicians help reduce it? Rural Remote Health. 2009;9(3):1146. PubMed
Olson RA, Nichol A, Caron NR, Olivotto IA, Speers C, Chia S, et al. Effect of community population size on breast cancer screening, stage distribution, treatment use and outcomes. Can J Publ Health. 2012;103(1):46–52.
Rosenbaum AJ, Gage JC, Alfaro KM, Ditzian LR, Maza M, Scarinci IC, et al. Acceptability of self-collected versus provider-collected sampling for HPV DNA testing among women in rural El Salvador. Int J Gynecol Obstet. 2014;126(2):156–60. CrossRef
Provincial Cervical Screening Initiatives Program, Newfoundland & Labrador. [ http://westernhealth.nl.ca/index.php/programs-and-services/services-a-z/provincial-cervical-screening-initiatives-program]
Statistics Canada. 2006 Community Profiles. In: 2006 Census. Statistics Canada Catalogue no. 92-591-XWE. 2006.
Statistics Canada. 2011 Community Profiles. In: 2011 Census. Statistics Canada Catalogue no. 98-316-XWE. 2011.
Canadian Partnership Against Cancer. Cervical cancer screening in Canada: monitoring program performance 2006–2008. Toronto: Canadian Partnership Against Cancer; 2011.
Canadian Partnership Against Cancer. Cervical cancer screening in Canada: monitoring performance 2009–2011. Toronto: Canadian Partnership Against Cancer; 2013.
Cancer Care Manitoba: Colorectal Cancer Screening Outcomes 2009–2010. [ http://www.cancercare.mb.ca/resource/File/ColonCheck/Colon_Cancer_Screening_Outcomes_09-10_Apr13.pdf]
Cancer Care Ontario: ColonCancerCheck Program Report. [ https://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=226298]
Lynn B, Olatunbosun T, Wu C, Barker T. Update on breast cancer screening: literature review and environmental scan. St. John’s: Faculty of Medicine, Memorial University of Newfoundland; 2011.
- Effect of vaginal self-sampling on cervical cancer screening rates: a community-based study in Newfoundland
- BioMed Central
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