Self-sampling to improve cervical cancer screening coverage in Switzerland: a randomised controlled trial

Abstract

Background: The aim of this study is to evaluate whether self-sampling can increase screening attendance of women who do not attend regular screening in Switzerland.

Methods: Participants were proactively recruited in Geneva between September 2011 and November 2015. Women (25-69 years) who had not undergone CC screening in the last 3 years were considered eligible. Through a 1 : 1 ratio randomisation, enrolled participants were invited to either undergo liquid-based cytology, which was performed by a health-care provider (control group, CG) or to take a self-sample for HPV-testing, which was mailed to their home (intervention group, IG).

Results: A total of 331 and 336 women were randomised in the CG and in the IG, respectively. Overall, 7.3% (95% CI: 4.9-10.6) women in the CG and 5.7% (95% CI: 3.6-8.7) women in the IG did not undergo the initial screening (P=0.400). There were 1.95% (95% CI: 0.8-4.3) women in the CG and 5.05% (95% CI: 3.1-8.1) women in the IG with a positive screen who did not attend triage and colposcopy (P=0.036).

Conclusions: The participation in CC screening in women offered self-sampling was not higher than among those offered specimen collection by a clinician. Compliance with further follow-up for women with a positive HPV test on the self-sample requires further attention.

Figure 1

Study flowchart. HPV=Human Papillomavirus; ASC-US=Atypical squamous cells of undetermined significance; ASC-US+=Atypical squamous cells of undetermined significance or worse; ASC-H=Atypical squamous cells of undetermined significance cannot exclude HSIL; L-SIL=Low-grade squamous intra-epithelial lesion; HSIL=High-grade squamous intra-epithelial lesion.