title: Effect of vaginal self-sampling on cervical cancer screening rates: a community-based study in Newfoundland.
abstract: BACKGROUND
  Cervical cancer is highly preventable and treatable if detected early through regular screening. Women in the Canadian province of Newfoundland & Labrador have relatively low rates of cervical cancer screening, with rates of around 40 % between 2007 and 2009. Persistent infection with oncogenic human papillomavirus (HPV) is a necessary cause for the development of cervical cancer, and HPV testing, including self-sampling, has been suggested as an alternative method of cervical cancer screening that may alleviate some barriers to screening. Our objective was to determine whether offering self-collected HPV testing screening increased cervical cancer screening rates in rural communities.
  
  
  METHODS
  During the 2-year study, three community-based cohorts were assigned to receive either i) a cervical cancer education campaign with the option of HPV testing; ii) an educational campaign alone; iii) or no intervention. Self-collection kits were offered to eligible women at family medicine clinics and community centres, and participants were surveyed to determine their acceptance of the HPV self-collection kit. Paired proportions testing for before-after studies was used to determine differences in screening rates from baseline, and Chi Square analysis of three dimensional 2 × 2 × 2 tables compared the change between communities.
  
  
  RESULTS
  Cervical cancer screening increased by 15.2 % (p < 0.001) to 67.4 % in the community where self-collection was available, versus a 2.9 % increase (p = 0.07) in the community that received educational campaigns and 8.5 % in the community with no intervention (p = 0.193). The difference in change in rates was statistically significant between communities A and B (p < 0.001) but not between communities A and C (p = 0.193). The response rate was low, with only 9.5 % (168/1760) of eligible women opting to self-collect for HPV testing. Of the women who completed self-collection, 15.5 % (26) had not had a Pap smear in the last 3 years, and 88.7 % reported that they were somewhat or very satisfied with self-collection.
  
  
  CONCLUSIONS
  Offering self-collected HPV testing increased the cervical cancer screening rate in a rural NL community. Women who completed self-collection had generally positive feelings about the experience. Offering HPV self-collection may increase screening compliance, particularly among women who do not present for routine Pap smears.
authors.affiliation: Primary Healthcare Research Unit, Memorial University, St John's, Canada. pduke@mun.ca.|Discipline of Family Medicine, Memorial University, Newfoundland & Labrador, Primary Healthcare Research Unit, Room 424, Janeway Hostel, 300 Prince Philip Drive, St. John's, A1B 3 V6, NL, Canada. pduke@mun.ca.
authors.forename: Pauline
authors.initials: P
authors.lastname: Duke
authors.affiliation: Primary Healthcare Research Unit, Memorial University, St John's, Canada. godwinm@mun.ca.|Discipline of Family Medicine, Memorial University, Newfoundland & Labrador, Primary Healthcare Research Unit, Room 424, Janeway Hostel, 300 Prince Philip Drive, St. John's, A1B 3 V6, NL, Canada. godwinm@mun.ca.
authors.forename: Marshall
authors.initials: M
authors.lastname: Godwin
authors.affiliation: Public Health Laboratories, Eastern Health Authority, St. John's, Canada. Sam.ratnam@easternhealth.ca.
authors.forename: Samuel
authors.initials: S
authors.lastname: Ratnam
authors.affiliation: Department of Obstetrics and Gynecology, Memorial University, St. John's, Canada. lmdawson@mun.ca.
authors.forename: Lesa
authors.initials: L
authors.lastname: Dawson
authors.affiliation: Department of Pathology, Eastern Health Authority, St. John's, Canada. hickeyfontaine@hotmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fontaine
authors.affiliation: Cancer Clinic, Eastern Health Authority, St. John's, Canada. adrian.lear@easternhealth.ca.
authors.forename: Adrian
authors.initials: A
authors.lastname: Lear
authors.affiliation: Community Health and Humanities, Memorial University, St. John's, Canada. mtraverso@mun.ca.
authors.forename: Martha
authors.initials: M
authors.lastname: Traverso-Yepez
authors.affiliation: Discipline of Family Medicine, Memorial University, Newfoundland & Labrador, Primary Healthcare Research Unit, Room 424, Janeway Hostel, 300 Prince Philip Drive, St. John's, A1B 3 V6, NL, Canada. Wendy.graham@med.mun.ca.
authors.forename: Wendy
authors.initials: W
authors.lastname: Graham
authors.affiliation: Discipline of Family Medicine, Memorial University, Newfoundland & Labrador, Primary Healthcare Research Unit, Room 424, Janeway Hostel, 300 Prince Philip Drive, St. John's, A1B 3 V6, NL, Canada. ravalia@mun.ca.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Ravalia
authors.affiliation: Department of Psychiatry, Memorial University, St. John's, Canada. gmugford@mun.ca.
authors.forename: Gerry
authors.initials: G
authors.lastname: Mugford
authors.affiliation: Primary Healthcare Research Unit, Memorial University, St John's, Canada. Andrea.pike@med.mun.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pike
authors.affiliation: Primary Healthcare Research Unit, Memorial University, St John's, Canada. Jacqueline.fortier@med.mun.ca.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Fortier
authors.affiliation: Primary Healthcare Research Unit, Memorial University, St John's, Canada. c64mep@mun.ca.
authors.forename: Mandy
authors.initials: M
authors.lastname: Peach
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009523:Newfoundland and Labrador / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D012424:Rural Population; D016353:Self-Examination / Q000379:methods*; D013048:Specimen Handling / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D014621:Vagina; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis