Human papillomavirus (HPV) testing on self-samples represents a great opportunity to increase cervical cancer screening uptake among under-screened women.
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.
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%).
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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The datasets generated during and/or analysed during this study are available from the corresponding author on reasonable request.
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Horizon 2020 Framework Programme for Research and Innovation of the European Commission and the US National Cancer Institute/NIH/DHHS.
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. ). 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.
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