title: 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.
abstract: RACOMIP is a population-based, randomized trial of the effectiveness and cost-effectiveness of different interventions aimed at increasing participation in a well-run cervical cancer screening program in western Sweden. In this article, we report results from one intervention, offering non-attendees a high-risk human papillomavirus (HPV) self-test. Comparison was made with standard screening invitation routine or standard routine plus a telephone call. Women (8,800), aged 30-62, were randomly selected among women without a registered Pap smear in the two latest screening rounds. These women were randomized 1:5:5 to one of three arms: 800 were offered a high-risk HPV self-test, 4,000 were randomized to a telephone call (reported previously) and 4,000 constituted a control group (standard screening invitation routine). Results were based on intention to treat analysis and cost-effectiveness was calculated as marginal cost per cancer case prevented. The endpoint was the frequency of testing. The total response rate in the self-testing arm was 24.5%, significantly higher than in the telephone arm (18%, RR 1.36, 95% CI 1.19-1.57) and the control group (10.6%, RR 2.33, 95% CI 2.00-2.71). All nine women who tested positive for high-risk HPV attended for a cervical smear and colposcopy. From the health-care sector perspective, the intervention will most likely lead to no additional cost. Offering a self-test for HPV as an alternative to Pap smears increases participation among long-term non-attendees. Offering various screening options can be a successful method for increasing participation in this group.
authors.affiliation: The Regional Cancer Centre, Western Health Care Region, Gothenburg, Sweden; The Department of Obstetrics and Gynaecology, Institute of Clinical Science, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Broberg
authors.forename: Dorte
authors.initials: D
authors.lastname: Gyrd-Hansen
authors.forename: Junmei
authors.initials: J
authors.lastname: Miao Jonasson
authors.forename: Mare-Liis
authors.initials: ML
authors.lastname: Ryd
authors.forename: Mikael
authors.initials: M
authors.lastname: Holtenman
authors.forename: Ian
authors.initials: I
authors.lastname: Milsom
authors.forename: Björn
authors.initials: B
authors.lastname: Strander
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D012648:Self Care / Q000191:economics / Q000379:methods*; D013548:Sweden; D013689:Telephone; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears
keywords: HPV; cervical intraepithelial neoplasia; mass screening; non-attendance; papanicolaou smear