Offering self-sampling to cervical screening non-attenders in primary care

Area of Science:

• Public Health
• Gynecologic Oncology
• Screening Programs

Background:

• Cervical cancer screening non-attendance remains a significant public health issue.
• Opportunistic outreach in primary care may engage under-screened populations.
• Human Papillomavirus (HPV) testing is a key component of modern cervical screening.

Purpose of the Study:

• To evaluate the feasibility and acceptability of offering HPV self-sampling kits to cervical screening non-attenders during primary care consultations.
• To determine the uptake and return rates of self-sampling kits in this population.
• To assess the potential for opportunistic screening in primary care settings.

Main Methods:

• A pilot implementation study conducted in six London general practices.
• Eligible women (aged 25-64, overdue for screening) were identified via real-time electronic medical record searches.
• Self-sampling kits were offered during consultations, with samples collected in-clinic or at home for HPV analysis.

Main Results:

• Of ~5000 eligible women, 3131 attended primary care; 21% were offered kits, 14% accepted, and 9% returned a sample.
• Offer rates varied significantly between practices (11-36%).
• Higher offer rates correlated with increased sample return rates (r=0.8, p=0.04).
• 39 HPV-positive women were identified, with 85% attending follow-up, including two with invasive cervical cancers.

Conclusions:

• Opportunistic offering of HPV self-sampling in primary care is a feasible strategy to reach cervical screening non-attenders.
• Improving the rate at which kits are offered is crucial for increasing sample return.
• Further large-scale trials are needed to optimize integration into national screening programs and identify uptake determinants.