HPV self-sampling in organized cervical cancer screening program: A randomized pilot study in Estonia in 2021

Area of Science:

• Public Health
• Oncology
• Preventive Medicine

Background:

• Estonia faces high cervical cancer rates, with low screening attendance.
• Organized screening programs struggle with low participation rates.

Purpose of the Study:

• To assess the impact of opt-in and opt-out human papillomavirus (HPV) self-sampling on cervical cancer screening participation.
• To compare the effectiveness of different invitation strategies for HPV screening.

Main Methods:

• A randomized controlled trial involving over 55,000 women due for screening.
• Intervention arms included opt-out (pre-mailed self-sampler) and opt-in (e-mail link to order self-sampler) strategies.
• A control group received standard screening reminders.

Main Results:

• Participation was significantly higher in the opt-out (41.7%) and opt-in (34.1%) arms compared to the control group (29.0%).
• The opt-out strategy showed higher overall participation than the opt-in strategy.
• Self-sampling was highly rated for ease of use (99%), with most users preferring it for future testing.

Conclusions:

• Offering a choice between HPV self-sampling and clinician sampling boosts cervical cancer screening participation.
• Tailoring opt-in/opt-out strategies to different age groups may optimize screening effectiveness.
• HPV self-sampling is a user-friendly and effective method for increasing screening coverage.