Participation and relative cost of attendance by direct-mail compared to opt-in invitation strategy for HPV self-sampling targeting cervical screening non-attenders: A large-scale, randomized, pragmatic study

IF 5.7 2区 医学 Q1 ONCOLOGY International Journal of Cancer Pub Date : 2024-11-23 DOI:10.1002/ijc.35263
Birgitte Tønnes Pedersen, Si Brask Sonne, Helle Pedersen, Emilie Korsgaard Andreasen, Reza Serizawa, Ditte Møller Ejegod, Jesper Bonde
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Abstract

Broad accessibility to cervical cancer screening and high participation rate is essential to reduce cervical cancer incidence. HPV self-sampling is an alternative to clinician collected cervical samples to increase accessibility and screening coverage. To inform on deployment strategies of HPV self-sampling, this large-scale, randomized, pragmatic study compared two invitation modalities; direct-mail and opt-in. The study included screening non-attenders from the Capital Region of Denmark randomly allocated (1:4) to a direct-mail or opt-in invitation for cervical screening by HPV self-sampling. Primary endpoint was screening participation; secondary endpoints were HPV prevalence and histology outcome. Adherence to follow-up and cost were also evaluated. After exclusion of hysterectomized/non-accessible women, 49,393 women were invited: 9639 by direct-mail, and 39,754 by the opt-in offer. A direct-mail invitation for HPV self-sampling yielded a significant higher participation than an opt-in invitation. HPV self-sample participation for direct-mail was 25.2% (n = 2426), opt-in participation was 20.2% (n = 8047), adjusted OR = 1.27, 95% CI 1.20–1.34. Participation increased with age (p < .0001) for both strategies and decreased with screening history of non-attendance (p < .0001). Interaction between invitation strategy and age/screening history was found; more women below 50 years of age participated by direct-mail compared to opt-in (p < .0001) and higher participation by direct-mail group was found in women with a short history of non-attendance (p < .0001). Participation of long-term unscreened women was similar between arms. The relative cost was ≈14 HPV self-sample kits distributed per additional participant by direct-mail over opt-in. HPV prevalence, adherence to follow-up, and detection of high-grade cervical intraepithelial neoplasia was similar between invitation strategies.

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针对未参加宫颈筛查者的 HPV 自我采样,采用直邮方式与选择邀请方式的参与率和相对参加成本进行比较:一项大规模、随机、务实的研究。
宫颈癌筛查的普及性和高参与率对于降低宫颈癌发病率至关重要。HPV 自我采样是临床医生收集宫颈样本的一种替代方法,可提高筛查的可及性和覆盖率。为了解 HPV 自采样的部署策略,这项大规模、随机、务实的研究比较了两种邀请方式:直接邮寄和选择加入。研究对象包括来自丹麦首都地区的未参加筛查者,他们被随机分配(1:4)到直邮或选择邀请方式,接受 HPV 自我采样进行宫颈筛查。主要终点是筛查参与度;次要终点是 HPV 感染率和组织学结果。此外,还对随访的依从性和成本进行了评估。在排除了子宫切除/无法接受筛查的妇女后,共邀请了 49393 名妇女参加筛查:其中,9639 名妇女通过直邮方式接受了邀请,39754 名妇女通过选择接受邀请的方式接受了邀请。直接邮寄 HPV 自我采样邀请函的参与率明显高于选择邀请函。直接邮寄的 HPV 自我采样参与率为 25.2%(n = 2426),选择参与的参与率为 20.2%(n = 8047),调整 OR = 1.27,95% CI 1.20-1.34。参与率随年龄增长而增加(p
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来源期刊
CiteScore
13.40
自引率
3.10%
发文量
460
审稿时长
2 months
期刊介绍: The International Journal of Cancer (IJC) is the official journal of the Union for International Cancer Control—UICC; it appears twice a month. IJC invites submission of manuscripts under a broad scope of topics relevant to experimental and clinical cancer research and publishes original Research Articles and Short Reports under the following categories: -Cancer Epidemiology- Cancer Genetics and Epigenetics- Infectious Causes of Cancer- Innovative Tools and Methods- Molecular Cancer Biology- Tumor Immunology and Microenvironment- Tumor Markers and Signatures- Cancer Therapy and Prevention
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