Increased attendance and reduced inequity in cervical cancer screening
Article
|Last update
A key step to make cervical cancer prevention more efficient is by removing barriers to screening attendance. In this research project, we have examined whether self-sampling can increase attendance to screening among long term non-attenders and improve cervical cancer prevention in Norway.
Background and aim
About one third of Norwegian women do not attend screening against cervical cancer as often as recommended by the national screening program CervicalScreen Norway. Immigrants and women that are unemployed are overrepresented among the group of under-screened women. It is important to gain more knowledge on how to overcome the barriers to cervical cancer screening faced by under-screened women.
In this study, we have examined whether a self-collected screening sample taken at home by the woman herself can increase attendance to cervical cancer screening among women who have not been screened for at least ten years. The study also assesses whether self-sampling may reduce social inequity in screening attendance.
The self-collected screening samples were tested for human papillomavirus (HPV). In an earlier study we have shown that HPV analyses on self-samples collected by women themselves performs equally well as screening samples taken by a physician.
Self-collected screening samples increases attendance to screening programme
We performed a randomized control trial to compare the screening attendance among women who receive (i) the usual reminder from CervicalScreen Norway to be screened, (ii) a self-sampling test kit ready to use by post, and (iii) an offer to place an order for a self-sampling test kit. 6000 randomly selected women between the ages of 35 to 69 who have not been screened for cervical cancer for at least a decade were invited to participate in this study. The trial demonstrated 23% higher participation rate among long-term non-attending women who got a self-sampling kit by mail as compared to those who received a regular invitation, clearly suggesting that self-sampling increases screening participation among those who do not attend regularly.
In addition, we also assessed the best follow-up method for women with a positive HPV test result. Half of the HPV-positive women were referred to a gynaecologist whereas the other half received a follow-up appointment with their regular general practitioner.
It is no longer possible to order the self-sampling test as the recruitment to the study has been completed.
Self-sampling is more feasible for some women
We also carried out a qualitative focus group study where we interviewed long-term non-attending women about their views on cervical cancer screening attendance. The results from the study showed that women who are overdue for screening hesitate to book a screening appointment for various reasons: “it is easy to forget about it”, “you have to arrange your own appointment”, “it has to be a must”, or “pelvic examination is humiliating”. How women perceive cervical cancer screening depends on how the screening programme portraits the importance of screening, how well the women are encouraged to attend and how the screening is facilitated by the health care services.
Recruitment and biological samples donated
The biological material from the women who have given their consent is stored in the general research biobank TREASURE-HPV for use in future research (REC# 2014/667).
About the project
Project members
- Mari Nygård, project leader
- Gunvor Aasbø, post-doc
- Bo Terning Hansen – Researcher and previous project leader
- Ståle Nygård - Researcher
- Elen Johanne Lahlum - Advisor
- Eva Wessel Stratford – Senior Advisor
- Jo Waller - Researcher
- Christine Jonassen –Director
- Mona Hansen – Senior Engineer
Previous Key project members
- Karina Undem
Collaborators
- University College London
- University of Oslo
- Albert Einstein College of Medicine
- University of Bergen
- Akershus University Hospital
- Harvard University
Project period
2017 - 2029
Ethics
The project has been approved by the Regional Committees for Medical and Health Research Ethics (2017/1017, 2019/111, 2014/667).
Financing
The project has been financed by The Norwegian Cancer Society and Thea Steens memorial fund.
Publications
Aasbø G, Tropè A, Nygård M, Christiansen IK, Baasland I, Iversen GA, Munk AC, Christiansen MH, Presthus GK, Undem K, Bjørge T, Castle PE, Hansen BT. HPV self-sampling among long-term non-attenders to cervical cancer screening in Norway: a pragmatic randomised controlled trial. Br J Cancer. 2022 Nov;127(10):1816-1826. doi: 10.1038/s41416-022-01954-9. Epub 2022 Aug 23. PMID: 35995936; PMCID: PMC9643532.