Self-sample Hpv-tests as an Intervention for Non-attendees of Cervical Cancer Screening in Finland: a Randomised Trial

Background: Attendance in screening is an important determinant of cervical cancer. Previous experience on high-risk human papillomavirus (hrHPV) DNA testing on patient-obtained samples suggests a good effect among non-attendees of screening. We assessed the effects of self-sampling on attendance in the Finnish screening programme. Methods: Non-attendees after the primary invitation in one municipality (Espoo) were randomised to receive either a self-sampling kit (2,397 women) or an extra invitation (6,302 women). One fourth (1,315 women) of reminder-letter arm non-attendees also received a self-sampling kit as a third intervention. Main outcomes were increases in screening attendance and coverage. Results: The adjusted relative risk (RR) for participation by self-sampling as a second intervention in comparison to a reminder letter was 1.21 (CI 1.13-1.30). Total attendance increased from 65% to 76% by self-sampling, and from 65% to 74% with a reminder letter. Combining the interventions (reminder letter, then self-sampling) increased total attendance from 63% to 78%. One fifth of the participants in all three groups increased screening coverage (previous Pap-smear ≥5 years ago or never). Self-obtained samples were more often HPV-positive than provider-obtained ones (participants after primary invitation and reminder letter), 12-13% versus 7%. Conclusions: Self-sampling is a feasible option in enhancing the attendance at organised screening, particularly as an addition to a reminder letter. Impact: If self-sampling is used as a third intervention after two written invitations, the overall attendance in Finland could most likely reach the desired 80-85%. on October 20, 2017. © 2011 American Association for Cancer Research. cebp.aacrjournals.org Downloaded from Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Author Manuscript Published OnlineFirst on July 13, 2011; DOI: 10.1158/1055-9965.EPI-11-0307