Cervical cancer screening doubled as less-screened women submitted

CHAPEL HILL, NC — Researchers at UNC Gillings School of Global Public Health and UNC Lineberger Comprehensive Cancer Center found sending out self-collection human papillomavirus (HPV) tests and offering help booking in-clinic screening appointments to people who are less screened, Low-income women improve cervical cancer screening almost two-fold compared with scheduling aids alone. Scheduling assistance primarily consists of helping to make appointments for in-office examinations, regardless of whether an at-home test is offered or returned, or whether the HPV test is negative or positive.

Findings from the randomized trial appeared May 11, 2023, in Lancet Public Health.

“My hope in this study was that delivery kits for home collections might improve cervical cancer screening, but we were very pleased to find a nearly two-fold increase in screening uptake,” said Jennifer S. Smith, PhD, MPH of UNC Lineberger. , professor of epidemiology at UNC’s Gillings and corresponding author of the study. “Many have not been involved in screening systems for a while and bringing kits into their homes helps break down fundamental barriers.”

An estimated 14,000 women will be diagnosed with cervical cancer in the United States this year, according to the National Cancer Institute, and the cancer will cause more than 4,300 deaths. Cervical cancer disproportionately affects black and Hispanic women, with Hispanic women having the highest incidence rates, and black women having the highest death rates from this disease in North Carolina and in the United States. Most cervical cancers occur in unscreened women. The Centers for Disease Control and Prevention estimates that 22% of eligible adults in the US are late for screening.

The My Body, My Test-3 study recruited 665 women, ages 25 to 64, who were not insured or enrolled in Medicaid or Medicare, from 22 counties across North Carolina. Low-income women and most of them live in urban areas. Neither had a pap test in four years or a high-risk HPV test in six years, making them late for screening.

Two-thirds of women receive an HPV self-collection kit sent in the mail followed by assistance with scheduling screening appointments at the clinic. Another third received help scheduling screenings alone. The primary outcome was attending a screening appointment at the clinic or testing HPV-negative with a self-collected sample within six months of enrollment in the trial.

Screening uptake was 72% among women who received delivered HPV kits compared to 37% for other groups of women. The researchers found that the effect of self-care outreach on screening uptake did not vary by age, race/ethnicity, time since last screening, Medicaid or Medicare insurance coverage, or education.

“At-home screening for cervical cancer puts women in control. Most can avoid having to go to a doctor’s appointment. These at-home kits can better reach people who don’t have access to screening, who are embarrassed by cervical screening, or whose religious beliefs include modesty, better,” said study co-author Noel T. Brewer, PhD, Gillings Distinguished Professor in Health Lineberger Society and UNC Members.

“We believe our results apply to low-income and under-screened women across the United States,” said Smith. “We are now working with clinical partners to identify women who may be late for screening via electronic medical records. We hope to provide the option of sending them a self-collection kit for home use to send back to us or handing the kit directly to them when they come to the clinic for other services with the vision of eventually making a self-collection. regular clinical provisions.”

The UNC researchers also hope their findings, along with those of previous studies, will spur the Food and Drug Administration to consider approving HPV self-collection as the primary screening test for cervical cancer in the US.

Author and Disclosure

Besides Smith and Brewer, the other authors are Peyton K. Pretsch, MPH, Lisa P. Spees, PhD, Michael G. Hudgens, PhD, Busola Sanusi, MA, Eliane Rohner, PhD, Elyse Miller, MPH, Sarah L. Jackson, MPH , and Stephanie B. Wheeler, PhD, MPH, UNC; Lynn Barclay, American Sexual Health Association, Research Triangle Park, NC; and Alicia Carter, MD, American Holdings Laboratory Company, Burlington, NC.

The My Body My Test-3 trial was funded by grant R01CA183891 from the National Cancer Institute. HPV testing reagent, self-collected sample preservation medium and liquid-based cytology media and cervical sample collection brush were donated by Hologic, Inc. The self-collection brush was donated by Rovers Medical Devices.

Smith has received research grants, supply endowments, and consulting for Hologic, Inc., BD Diagnostics, and Rovers Medical Devices in the last five years. Barclay works for the American Sexual Health Association which receives funding from Hologic. Neither Hologic, BD nor Rovers had any input into the study design, analysis or interpretation of the results. Wheeler receives grant support from Pfizer for unrelated projects. Other authors declare no conflict of interest.