title: Self-sampling in cervical cancer screening: comparison of a brush-based and a lavage-based cervicovaginal self-sampling device.
abstract: BACKGROUND
  High coverage and attendance is essential for cervical cancer screening success. We investigated whether the previous positive experiences on increasing screening attendance by self-sampling in Finland are sampler device dependent.
  
  
  METHODS
  All women identified to cervical cancer screening in 2013 in 28 Finnish municipalities were randomised to receive a lavage- (n = 6030) or a brush type of self-sampling device (n = 6045) in case of non-attendance after two invitation letters. Seven hundred seventy non-attending women in the lavage device group and 734 in the brush group received the self-sampling offer. Women's experiences were enquired with an enclosed questionnaire.
  
  
  RESULTS
  Total attendance in the lavage group increased from 71.0 to 77.7% by reminder letters and further to 80.5% by self-sampling. Respective increase in the brush group was from 72.2 to 78.6% and then to 81.5%. The participation by self-sampling was 21.7% (95% CI 18.8-24.6) in the lavage group and 23.8% (95% CI 20.8-26.9) in the brush group. Women's self-sampling experiences were mainly positive and the sampler devices were equally well accepted by the women.
  
  
  CONCLUSIONS
  Our study shows that the lavage device and brush device perform similarly in terms of uptake by non-attending women and user comfort. If self-sampling is integrated to the routine screening program in Finland, either of the devices can be chosen without the fear of losing participants due to a less acceptable device.
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland. liisa.karjalainen@helsinki.fi.
authors.forename: Liisa
authors.initials: L
authors.lastname: Karjalainen
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland.
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Jorvi Hospital, Turuntie 150, Espoo, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland.
authors.forename: Tapio
authors.initials: T
authors.lastname: Luostarinen
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130, Helsinki, Finland.
authors.forename: Anni
authors.initials: A
authors.lastname: Virtanen
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer; D005260:Female; D005387:Finland; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification* / Q000472:pathogenicity; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D012648:Self Care; D012959:Socioeconomic Factors; D013048:Specimen Handling; D011795:Surveys and Questionnaires; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
keywords: Acceptability; Cervical cancer screening; HPV; Self-sampling; Socio-demographic factors