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Effect of direct mailing self-sampling kits on participation in the Dutch hrHPV-based cervical screening programme: a
Ellen M G Olthof1, Albert G Siebers2, Inge M C M de Kok1
1Erasmus MC University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands.
Background:
In July 2023, the Dutch cervical cancer screening programme introduced direct mailing of self-sampling kits with invitations for 30-year-olds and with reminder for non-participants in other age groups after 12 weeks. This study evaluates the impact of this new policy on participation, self-sampling uptake, and follow-up testing.
Methods:
Data from the national screening (ScreenIT) and pathology (Palga) databases were used. Individuals invited between July 11 and December 31, 2023, were compared to a control group from the same period in 2022. Primary outcomes included participation rates following invitation and reminder, time to participation, self-sampling uptake, reflex cytology participation among high-risk HPV(hrHPV)-positive self-sampling participants, and first-time participation. Analyses were stratified by age and screening history.
Findings:
Overall participation increased from 42.1% (n = 330,413) in the control group to 49.9% (n = 327,376; RR: 1.19, 95% CI: 1.18-1.19) with the new policy. After primary invitation, the largest increase in participation from 30.6% to 40.3% was observed among 30-year-olds (RR: 1.32, 95% CI: 1.30-1.34). Vaginal self-sampling uptake increased from 21.9% to 61.9% (RR: 2.82, 95% CI: 2.79-2.85), with the largest uptake among first-time participants (previous non-attenders, 32.1%-78.1%; RR: 2.43, 95% CI: 2.35-2.51) and 30-34-year-olds (25.1%-83.7%; RR: 3.33, 95% CI: 2.25-3.40). The proportion of first-time participants increased from 6.8% in the control group to 9.1% with the new policy. Participation increased sharply in individuals aged 35+ after 12 weeks. Reflex cytology participation among hrHPV-positive self-sampling participants declined by 6% (from 93% to 87%; RR: 0.94, 95% CI: 0.93-0.95), but this did not affect the overall increase in participation rates.
Interpretation:
Direct mailing of self-sampling kits is an effective strategy to increase participation in population-based cervical cancer screening programmes, especially among first-time invitees and previous non-attenders. Continued participation in reflex cytology among hrHPV-positive women remains essential to maximise the overall impact of the policy on screening effectiveness.
Funding:
This study was funded by the National Institute for Public Health and the Environment.
