Direct mailing of self sampler human papillomavirus (HPV) DNA tests to non responders who had failed to take up invitations for cervical cancer screening programmes increased compliance in comparison with standard recall letters, reports an Italian study published in the British Journal of Cancer.

In most industrialised countries, the majority of invasive cervical cancers occur in women who have never been screened or who are under screened. As a result the greatest impact on cervical cancer prevention would be achieved by increased test coverage. The use of HPV DNA tests as a primary screen allows for the introduction of self-sampling, whereas the conventional Pap-test requires samples to be taken by health professionals. The availability of home, self-collected samples opens the opportunity to remove some of the barriers that may have discouraged women from participating in screening programmes. “Self-sampling is less time consuming and invasive as compared with tests performed at a clinic. It allows for privacy, reduces discomfort and women know nobody would have to handle their body,” write the authors of the study,  P Giorgi Rossi and colleagues from the Agency for Public Health (Rome, Italy).

In the study, that was performed within three organised screening programmes in Rome, Florence, and Abruzzo, Giorgi Rossi and colleagues randomised , 2480  non-responder women, aged 35 to 64 years,  into one of four arms. The first group received standard recall letters to perform the Pap-test (n=619);  the second group received standard recall letters to perform the HPV DNA test (n=617);  the third group was sent letters offering a self-sampler HPV test to be requested by phone (n=622); while the fourth group was directly sent the self samplers to their homes (n=622).  The main outcome was women undergoing  cervical cancer screening tests within three months of the communication from the investigators.

Results showed that compliance with standard recall letters was 13.9%;  that offering HPV testing at the clinic had a non significant effect on compliance (relative risk 1.08, 95% CI=0.82-1.41); that  letters offering the mailing of samplers at request had a compliance of 8.7%; while direct mailing of the self sampler had a compliance of 19.6 %.  The effect on compliance of direct mailing was observed only in the urban areas of Florence and Rome , and not in the more rural area of Abruzzo.

In a questionnaire, that was completed by 147 women, the most frequent reason given for failing to comply with previous screening invitations was a recent Pap-test (40.6%), followed by lack of time (22.8%), and not receiving the letter (14.9%). Only 2% of respondents had failed to take part in the initial invitation because they thought that the procedure was embarrassing.

“Self-sampling for HPV testing is acceptable to women and mailing a device for HPV DNA self-collection to non-responders to cervical cancer screening may increase compliance as compared with standard recall letters,” write the authors, adding that the positive effect on compliance was only observed in Florence and Rome, and not in Abruzzo.

“Many context factors might explain this difference: there could be cultural and behavioural differences between urban and rural areas, or there may be more logistical problems in shipping self-sampler boxes,” write the authors, adding that one final complication is that the trial in Abruzzo was performed in mid-July, a time when compliance is low due to the close proximity of the summer holidays.

Reference

P Giorgi Rossi, LM Marsili, L Camilloni et al. The effect of self-sampled HPV testing on participation to cervical cancer screening in Italy: a randomised controlled trial. British Journal of Cancer  2011. 104, 248-254.