Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Area of Science:

• Public Health
• Gynecologic Oncology
• Health Services Research

Background:

• Limited data exist on mailed self-collection effectiveness for increasing cervical cancer screening (CCS) in underresourced settings.
• Safety-net health systems often face challenges in achieving optimal CCS coverage.

Purpose of the Study:

• To compare the effectiveness of mailed self-collection kits, with and without patient navigation, against telephone reminders for increasing CCS participation.
• To evaluate interventions aimed at improving CCS in a safety-net health system.

Main Methods:

• A pragmatic, randomized clinical trial was conducted in a safety-net health system.
• Participants were randomized into three groups: telephone reminder (TR) only, TR with mailed self-collection (SC), and TR with mailed SC and patient navigation.
• CCS participation was assessed via clinic attendance or return of mailed kits within 6 months.

Main Results:

• The mailed self-collection (SC) group showed a 2.36 times higher relative participation compared to telephone reminder (TR) alone (23.7% difference).
• SC with patient navigation showed a 2.68 times higher relative participation compared to TR (29.2% difference), with modest additional gains.
• The study included 2474 participants, with 94% from racial or ethnic minoritized populations.

Conclusions:

• Mailed self-collection (SC) kits are effective in increasing cervical cancer screening (CCS) participation among underscreened patients in safety-net settings.
• While patient navigation provided modest additional benefits, SC alone significantly improved screening rates.
• SC should be considered in safety-net settings to address suboptimal CCS coverage.