title: HPV self-sampling or the Pap-smear: a randomized study among cervical screening nonattenders from lower socioeconomic groups in France.
abstract: Today in France, low attendance to cervical screening by Papanicolaou cytology (Pap-smear) is a major contributor to the 3,000 new cervical cancer cases and 1,000 deaths that occur from this disease every year. Nonattenders are mostly from lower socioeconomic groups and testing of self-obtained samples for high-risk Human Papilloma virus (HPV) types has been proposed as a method to increase screening participation in these groups. In 2011, we conducted a randomized study of women aged 35-69 from very low-income populations around Marseille who had not responded to an initial invitation for a free Pap-smear. After randomization, one group received a second invitation for a free Pap-smear and the other group was offered a free self-sampling kit for HPV testing. Participation rates were significantly different between the two groups with only 2.0% of women attending for a Pap-smear while 18.3% of women returned a self-sample for HPV testing (p ≤ 0.001). The detection rate of high-grade lesions (≥CIN2) was 0.2‰ in the Pap-smear group and 1.25‰ in the self-sampling group (p = 0.01). Offering self-sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions (≥CIN2) in comparison to the group of women receiving a second invitation for a Pap-smear. However, low compliance to follow-up in the self-sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.
authors.affiliation: Department of prevention, Regional Cancer Centre, Montpellier, France.
authors.forename: H
authors.initials: H
authors.lastname: Sancho-Garnier
authors.forename: C
authors.initials: C
authors.lastname: Tamalet
authors.forename: P
authors.initials: P
authors.lastname: Halfon
authors.forename: F X
authors.initials: FX
authors.lastname: Leandri
authors.forename: L
authors.initials: L
authors.lastname: Le Retraite
authors.forename: K
authors.initials: K
authors.lastname: Djoufelkit
authors.forename: P
authors.initials: P
authors.lastname: Heid
authors.forename: P
authors.initials: P
authors.lastname: Davies
authors.forename: L
authors.initials: L
authors.lastname: Piana
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D008403:Mass Screening; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D012648:Self Care; D013048:Specimen Handling; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology
keywords: HPV self-sampling; attendance; cervical screening