title: Offering self-sampling to cervical screening non-attenders in primary care.
abstract: Objectives To assess the feasibility and acceptability of offering self-sampling for Human Papillomavirus (HPV) testing to cervical screening non-attenders when they consult primary care for any reason. Methods In a pilot implementation study, six general practices in London, UK, offered self-sampling kits during consultation to women aged 25-64 who were at least six months overdue for cervical screening (no cytology test recorded in the past 3.5 years if aged 25-49, or 5.5 years if aged 50-64). Eligible women were identified using an automated real-time search (during consultation) of the general practice electronic medical record system. Women collected samples either in clinic or at home (dry flocked swabs analysed using Roche Cobas®4800). Results Of approximately 5000 eligible women, 3131 consulted primary care between January and December 2014 (mean recruitment period 9.5 months). Of these, 21% (652) were offered kits, 14% (443) accepted, and 9% (292) returned a self-sample. The proportion of eligible women offered kits varied considerably among practices (11-36%). Sample return rates increased with kit offered rates ( r = 0.8, p = 0.04). Of 39 HPV positive women 85% (33) attended follow-up, including two with invasive cancers (stage 2A1 and 1A1). Conclusions Offering self-sampling to cervical screening non-attenders opportunistically in primary care is feasible. Return rates could be increased if more women were offered kits. A large trial is needed to identify how self-sampling is best integrated into the national screening programme, and to identify determinants of uptake.
authors.affiliation: 1 Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, London, UK.
authors.forename: Anita Ww
authors.initials: AW
authors.lastname: Lim
authors.affiliation: 2 Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Hollingworth
authors.affiliation: 3 Amersham Vale Training Practice, Waldron Health Centre, London, UK.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kalwij
authors.affiliation: 4 Division of Cellular Pathology, Barts Health NHS Trust, London, UK.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Curran
authors.affiliation: 1 Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Sasieni
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008131:London; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology; D010349:Patient Compliance; D011320:Primary Health Care; D013048:Specimen Handling; D013222:State Medicine; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
keywords: Self-sampling; cervical screening; human papillomavirus; non-attenders; primary care