Self-sampling experiences among non-attendees to cervical screening
Introduction
High coverage and attendance is essential for effective cervical cancer screening. Personal invitations to screening, pre-booked appointments in invitation letters and reminders sent to non-attendees increase screening attendance [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Self-sampling for high risk human papillomavirus (hrHPV) DNA testing helps to further increase attendance among women who are not reached by the routine screening program [9], [10], [11], [12], [13], [14], [15], [16]. Information on self-sampling experiences is needed to further optimize attendance by this method.
Acceptability of self-sampling, in the meaning of women's experience of the procedure, not solely response rate, has been previously studied by focus group discussions and questionnaires with self-sampling being introduced but not necessarily used by the participants [17], [18], [19], [20], [21], [22], [23], [24], and in comparison to a Pap-smear among screening participants or patients at a clinic [25], [26], [27], [28]. In countries with existing and functional screening programs, however, the current role of self-sampling would be to provide an alternative for women reluctant to participate in clinic-based screening. For this purpose, acceptability should be studied in the actual target group, i.e. among non-attendees to the current program. Some studies have gathered information on non-attending women's preferences for self-collection or clinician-collection and the reasons for their preference [15], [29], [30]. Only previous one study thus far has explored the aspects of user-friendliness of a self-sampling procedure in a population-based setting among non-attendees [31].
We studied women's experiences and perceptions on self-sampling based screening among non-attendees to cervical screening in a diverse set of Finnish municipalities. We further studied how demographic factors such as age, mother tongue and education level affect the self-sampling experience. In order to explore what kind of barriers to traditional screening can be overcome with the self-sampling option, women's reasons for non-attendance to routine screening were also studied.
Section snippets
Material and methods
In the Finnish program, all women aged 30–60 years are invited to screening by their home municipalities with personal invitations in 5-year intervals. The study population consisted of women who received two invitations to screening (primary invitation and a reminder letter) in 31 municipalities in years 2011 or 2012 and did not attend. These non-attendees were included in a clinical trial on the effects and feasibility of self-sampling described in detail elsewhere [32]. The women were offered
Response rate and characteristics of the responders
In total, 1326 originally non-attending women returned the questionnaire, 28% of all recipients of the questionnaire. 909 (68.6%) of the responders took part in screening with a self-taken sample. The demographic characteristics of the whole study population and of the questionnaire responders are shown in Table 1.
Among the self-sampling participants, response rate to the questionnaire was 98.8% (909/920) and no significant demographic differences were seen among responders and non-responders
Discussion
Cervical cancer screening in Finland has been effective in reducing incidence and mortality rates; in 2012 the incidence was 4.3/100,000 and mortality 0.9/100,000 woman-years [34]. A current challenge in Finland is the somewhat low participation rate to the organized program, at less than 70%, and extensive opportunistic screening that results in higher overall coverage but also costs with significant overscreening among some women. Reducing the number of opportunistic smears and increasing
In conclusion
What is the acceptability of self-sampling for HPV-testing among non-attendees to cervical screening in Finland? In terms of willingness to use, approximately 21% participated when offered the self-sampling option [9], [32]. In general, the participants had a good sampling experience, and negative experiences were reported rarely. However, response rate to the questionnaire among those non-attendees that declined also the self-sampling option was small and most likely affected by selection
Conflicts of interest statement
PN was a member of the GSK HPV-vaccine Endpoint Committee for HPV-vaccine trials. Other authors have no potential conflicts of interest.
Acknowledgments
The study received funding from the Academy of Finland (139622) and Finnish Cancer Society. AV received a personal grant from the Orion-Farmos Research Foundation.
The authors thank the staff of the Mass Screening Registry and in the laboratory of the Cancer Society of Finland for their valuable contribution.
References (36)
- et al.
How much does a reminder letter increase cervical screening among under-screened women in NSW?
Aust N Z J Public Health
(2005) - et al.
Offering self-sampling for human papillomavirus testing to non-attendees of the cervical screening programme: characteristics of the responders
Eur J Cancer
(2012) - et al.
Assessing women's willingness to collect their own cervical samples for HPV testing as part of the ASPIRE cervical cancer screening project in Uganda
Int J Gynaecol Obstet
(2011) - et al.
Reasons for non-attendance to cervical screening and preferences for HPV self-sampling in Dutch women
Prev Med
(2014) - et al.
Cervical cytology screening: a comparison of two call systems
BMJ
(1987) - et al.
Improving population-based cervical cancer screening in general practice: effects of a national strategy
Int J Qual Health Care
(1999) - et al.
The determinants of screening uptake and interventions for increasing uptake: a systematic review
Health Technol Assess (Rockv)
(2000) - et al.
Efficacy of patient letter reminders on cervical cancer screening
J Gen Intern Med
(2001) - et al.
A large population-based randomized controlled trial to increase attendance at screening for cervical cancer
Cancer Epidemiol Biomarkers Prev
(2004) - et al.
Cervical screening in general practice
Aust J Public Health
(2010)
Interventions targeted at women to encourage the uptake of cervical screening
Cochrane Database Syst Rev
Self-sample HPV tests as an intervention for nonattendees of cervical cancer screening in Finland: a randomized trial
Cancer Epidemiol Biomarkers Prev
Self-sampling versus reminder letter: effects on cervical cancer screening attendance and coverage in Finland
Int J Cancer
Self-sampling of the vaginal fluid at home combined with high-risk HPV testing
Br J Cancer
HPV self-sampling as an alternative strategy in non-attenders for cervical screening — a randomised controlled trial
Br J Cancer
HPV self-sampling or the Pap-smear: a randomized study among cervical screening nonattenders from lower socioeconomic groups in France
Int J Cancer
The effect of self-sampled HPV testing on participation to cervical cancer screening in Italy: a randomised controlled trial (ISRCTN96071600)
Br J Cancer
Increasing participation in cervical cancer screening: offering a HPV self-test to long-term non-attendees as part of RACOMIP, a Swedish randomized controlled trial
Int J Cancer
Cited by (48)
Experience with HPV self-sampling and clinician-based sampling in women attending routine cervical screening in the Netherlands
2019, Preventive MedicineCitation Excerpt :Previous studies among non-attendees who were offered self-sampling showed that women found self-sampling to be more convenient, less embarrassing, less uncomfortable and less painful as compared to clinician-based sampling (Sultana et al., 2015). In addition, women indicated that they would prefer self-sampling to clinician-based sampling for future screening (Bosgraaf et al., 2015; Sultana et al., 2015; Virtanen et al., 2014; Karjalainen et al., 2016). Results of the current study are in line with previous studies and show that experiences and preferences regarding self-sampling do also apply to a routine screening population.
Safety and acceptability of human papillomavirus testing of self-collected specimens: A methodologic study of the impact of collection devices and HPV assays on sensitivity for cervical cancer and high-grade lesions
2018, Journal of Clinical VirologyCitation Excerpt :Our results were consistent with the literature showing high acceptability and positive attitudes towards self-collection [4,8,12,20,39–46]. Similar to others, we did not observe differences in preference for self-collection based on age group, level of education or marital status [4,8,43,45,46]. In line with previous studies, the majority of women had more confidence in physician-specimens but they still preferred self-collection at home over standard clinical-sampling.