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Epidemiology

Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening

British Journal of Cancer volume 128, pages 805–813 (2023)Cite this article

Subjects

Abstract

Background

Human papillomavirus (HPV) testing on self-samples represents a great opportunity to increase cervical cancer screening uptake among under-screened women.

Methods

A systematic review and meta-analysis on randomised controlled trials (RCTs) were performed to update the evidence on the efficacy of strategies for offering self-sampling kits for HPV testing compared to conventional invitations and to compare different self-sampling invitation scenarios. Four experimental invitational scenarios were considered. Women in the control group were invited for screening according to existing practice: collection of a cervical specimen by a healthcare professional. Random-effects models were used to pool proportions, relative participation rates and absolute participation differences.

Results

Thirty-three trials were included. In the intention-to-treat analysis, all self-sampling invitation scenarios were more effective in reaching under-screened women compared to controls. Pooled participation difference (PD) and 95% confidence interval (CI) for experimental vs. control was 13.2% (95% CI = 11.0–15.3%) for mail-to-all, 4.4% (95% CI = 1.2–7.6%) for opt-in, 39.1% (95% CI = 8.4–69.9%) for community mobilisation & outreach and 28.1% (23.5–32.7%) for offer at healthcare service. PD for the comparison opt-in vs. mail-to-all, assessed in nine trials, was −8.2% (95% CI = −10.8 to −5.7%).

Discussion

Overall, screening participation was higher among women invited for self-sampling compared to control, regardless of the invitation strategy used. Opt-in strategies were less effective than send-to-all strategies.

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Fig. 1: Difference in participation rate between the self-sampling and the control arms of randomised trials.
Fig. 2: Difference in participation rate between opt-in and mail-to-all experimental groups of randomised trials.

Data availability

The datasets generated during and/or analysed during this study are available from the corresponding author on reasonable request.

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Acknowledgements

Horizon 2020 Framework Programme for Research and Innovation of the European Commission and the US National Cancer Institute/NIH/DHHS.

Funding

MA was supported by the Horizon 2020 Framework Programme for Research and Innovation of the European Commission, through the RISCC Network (Grant No. 847845); Sciensano the employer of MA and SC received funding in the framework VALHUDES, a researcher-induced protocol for evaluation of HPV tests on self-samples (see Arbyn et al. [66]). MA and SC did not receive any financial or material benefit from this project. BV was supported by the Horizon 2020 Framework Programme for Research and Innovation of the European Commission, through the ELEVATE project (Grant No. 825747). PEC was supported by the intramural research program (ZIACP101237-01) of the US National Cancer Institute/NIH/DHHS.

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Author notes

  1. These authors contributed equally: Stefanie Costa, Bo Verberckmoes.

Authors and Affiliations

  1. Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium

    Stefanie Costa & Marc Arbyn

  2. International Centre for Reproductive Health, Department of Public Health & Primary Care, Ghent University, Ghent, Belgium

    Bo Verberckmoes

  3. Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium

    Bo Verberckmoes

  4. Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA

    Philip E. Castle

  5. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    Philip E. Castle

  6. Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Marc Arbyn

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Contributions

MA designed the study concept and protocol. MA, SC and BV contributed to the data extraction, and SC conducted the statistical analysis. SC and BV co-wrote the drafts of the manuscript. MA and PEC provided critical revisions for the manuscript, and all co-authors provided final approval to publish. All authors had full access to the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Marc Arbyn.

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PEC has received HPV tests and assays for research at a reduced or no cost from Roche, Becton Dickinson, Cepheid and Arbor Vita Corporation.

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Costa, S., Verberckmoes, B., Castle, P.E. et al. Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening. Br J Cancer 128, 805–813 (2023). https://doi.org/10.1038/s41416-022-02094-w

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