A randomized controlled trial in non-responders from Newcastle upon Tyne invited to return a self-sample for Human Papillomavirus testing versus repeat invitation for cervical screening.
BACKGROUND
Non-attenders for cervical screening are at increased risk of cervical cancer. Studies offering self-sampling for high-risk Human Papillomavirus (HrHPV) testing have shown greater uptake than sending another invitation for cytology.


OBJECTIVE
To explore whether uptake would increase in a less diverse, more stable population than the previous English study, which demonstrated a lower response rate than other studies. The primary objective was whether non-attenders were more likely to respond to a postal invitation, including kit, to collect a self-sample compared with a further invitation for cytology screening. The secondary objective was whether women with an abnormal result would attend for follow-up.


METHODS
6000 non-attenders for screening in this pragmatic, randomized (1:1) controlled trial in Newcastle-upon-Tyne were sent an HPV self-sample kit (intervention) or a further invitation for cytology screening (comparator).


RESULTS
411(13%) responded to the intervention, returning a self-sample (247(8%)) or attending for cytology (164(5%)), compared with 183(6%) attending for cytology, relative risk 2.25 (95% CI 1.90-2.65) (comparator arm). Of those testing hrHPV positive (32(13%)), 19(59%) subsequently attended cytology screening. Of those in the intervention group who attended for cytology screening without returning an hrHPV self-sample (n = 164), 5% (n = 8) were referred for colposcopy - all attended. In the comparator group eight of the nine referred for colposcopy attended.


CONCLUSIONS
Persistent non-responders to invitations for cervical screening are significantly more likely to respond to a postal invitation to return a self-collected sample for HPV testing than a further invitation for cytology screening. However, just over half followed up on this positive HPV result.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, St. Bartholomew's School of Medicine and Dentistry, London, EC1M 6BQ.
Louise
L
Cadman
Department of Pharmacy, Health and Wellbeing, Faculty of Applied Sciences, Sciences Complex, City Campus, Chester Road, University of Sunderland, SR1 3SD scott.wilkes@sunderland.ac.uk.
Scott
S
Wilkes
Newcastle Hospitals, Community Health, New Croft Centre, Market Street (East), Newcastle upon Tyne, NE1 6ND.
Diana
D
Mansour
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, St. Bartholomew's School of Medicine and Dentistry, London, EC1M 6BQ.
Janet
J
Austin
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, St. Bartholomew's School of Medicine and Dentistry, London, EC1M 6BQ.
Lesley
L
Ashdown-Barr
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, St. Bartholomew's School of Medicine and Dentistry, London, EC1M 6BQ.
Rob
R
Edwards
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, St. Bartholomew's School of Medicine and Dentistry, London, EC1M 6BQ.
Michelle
M
Kleeman
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, St. Bartholomew's School of Medicine and Dentistry, London, EC1M 6BQ.
Anne
A
Szarewski
D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000302:isolation & purification; D004739:England; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis; D010349:Patient Compliance; D013048:Specimen Handling; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology
cervical screening; human papillomavirus; non-attenders; self-sampling