title: Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials.
abstract: BACKGROUND
  Population coverage for cervical cancer screening is an important determinant explaining differences in the incidence of cervical cancer between countries. Offering devices for self-sampling has the potential to increase participation of hard-to-reach women.
  
  
  METHODS
  A systematic review and meta-analysis were performed to evaluate the participation after an invitation including a self-sampling device (self-sampling arm) versus an invitation to have a sample taken by a health professional (control arm), sent to under-screened women.
  
  
  RESULTS
  Sixteen randomised studies were found eligible. In an intention-to-treat analysis, the pooled participation in the self-sampling arm was 23.6% (95% confidence interval (CI)=20.2-27.3%), when self-sampling kits were sent by mail to all women, versus 10.3% (95% CI=6.2-15.2%) in the control arm (participation difference: 12.6% [95% CI=9.3-15.9]). When women had to opt-in to receive the self-sampling device, as used in three studies, the pooled participation was not higher in the self-sampling compared to the control arm (participation difference: 0.2% [95% CI=-4.5-4.9%]).
  
  
  CONCLUSIONS
  An increased participation was observed in the self-sampling arm compared to the control arm, if self-sampling kits were sent directly to women at their home address. However, the size of the effect varied substantially among studies. Since participation was similar in both arms when women had to opt-in, future studies are warranted to discern opt-in scenarios that are most acceptable to women.
authors: Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium.
authors: F
authors: F
authors: Verdoodt
authors: Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany.
authors: M
authors: M
authors: Jentschke
authors: Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Str, 1, 30625 Hannover, Germany.
authors: P
authors: P
authors: Hillemanns
authors: Dalla Lana School of Public Health, University of Toronto, 155 College Street , 6th Floor, Toronto, Ontario M5T3M7, Canada.
authors: C S
authors: CS
authors: Racey
authors: Department of Pathology, VU University medical center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors: P J F
authors: PJ
authors: Snijders
authors: Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium. Electronic address: Marc.arbyn@wiv-isp.be.
authors: M
authors: M
authors: Arbyn
mesh_terms: D055088:Early Detection of Cancer / Q000295:instrumentation*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D057194:Intention to Treat Analysis; D010358:Patient Participation; D011177:Postal Service; D011237:Predictive Value of Tests; D012648:Self Care / Q000295:instrumentation*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000295:instrumentation*
keywords: Cervical cancer; HPV; Meta-analysis; Randomised trial; Screening attendance; Self-sampling