Strategies to Increase Cervical Cancer Screening With Mailed Human Papillomavirus Self-Sampling Kits: A Randomized...

Area of Science:

• Public Health
• Preventive Medicine
• Gynecologic Oncology

Background:

• Cervical cancer screening strategies need optimization based on patient history and healthcare setting.
• Mailing human papillomavirus (HPV) self-sampling kits is effective for overdue patients, but its impact on screening-adherent individuals is unevaluated in the US.

Purpose of the Study:

• To assess the effectiveness of direct-mail and opt-in strategies for offering HPV self-sampling kits.
• To evaluate these strategies across different cervical cancer screening histories: adherent, due, overdue, and unknown.

Main Methods:

• A randomized clinical trial was conducted in a US integrated healthcare system.
• Participants (aged 30-64) were stratified by screening history and randomized to usual care, education, direct-mail kits, or an opt-in option.
• Screening completion within 6 months was the primary outcome.

Main Results:

• Direct-mail self-sampling increased screening by 14.1% in due individuals and 16.9% in overdue individuals compared to education alone.
• The opt-in approach yielded smaller increases of 3.5% (due) and 2.2% (unknown history).
• Screening adherence varied significantly based on the outreach method and patient's screening history.

Conclusions:

• Direct-mail HPV self-sampling is a highly effective strategy to increase cervical cancer screening for individuals due or overdue.
• Healthcare systems should prioritize direct-mail outreach for these populations to improve screening adherence.
• Further research is needed to optimize outreach for individuals with unknown screening histories.