Introducing self-sampling for cervical cancer screening: A regional implementation study in Pirkanmaa, Finland

HPV primary testing is the preferred method for cervical cancer screening worldwide and enables vaginal self-sampling at home. Self-sampling performs comparably to clinician-collected samples and can improve participation, especially among non-attenders. In Finland, self-sampling has so far been piloted in the Helsinki region. This study evaluated the feasibility and acceptability of self-sampling in Pirkanmaa, providing a representative model of implementation outside the capital region.

The self-sampling in cervical cancer routine screening (FALCON) study (NCT06931184) targeted women living in Pirkanmaa who did not respond to the initial cervical cancer screening invitation. In a reminder letter, they were offered an opt-in model self-sampling option. Participants ordered a self-sampling kit containing a FLOQSwab (Copan), instructions, and a prepaid return envelope. Samples were analyzed with the Roche Cobas 4800 HPV assay at Fimlab Laboratories. HPV-positive women were referred for cytology testing and managed according to national guidelines. Participants completed two online questionnaires: one at kit order and another 60 days later.

Of 16 289 reminder letters, 329 kits were ordered, and 304 (1.9%) samples were returned. Participants (mean age 48 [range 29.9-65.8]) were mostly well-educated with previous screening history. Time-saving, reduced discomfort, and lower embarrassment were the main reasons for choosing home-sampling. HPV was detected in 6.9% of the samples, with one case of histological HSIL identified. Most participants found self-sampling easy and comfortable, and nearly all would recommend it to others.

Despite the small number of participants in this first year, the study offers early evidence of the strong acceptability and practicality of self-sampling among women in Pirkanmaa, warranting further evaluation at a larger scale.