In a recent study, under-screened patients were more likely to receive cervical cancer screening after receiving at-home high-risk human papillomavirus sampling kits.
Rates of cervical cancer screening in under-screened women of low-income backgrounds are improved by at-home high-risk human papillomavirus (hrHPV) sampling kits, according to a recent clinical trial published in The Lancet Public Health.
Persistent hrHPV infection is the leading cause of cervical cancer, increasing the risk of precancerous cervical lesions incidence. Black and Hispanic women are especially at risk, with Hispanic women experiencing higher rates of infection and Black women experiencing higher rates of mortality.
Research has indicated decreased risk of hrHPV incidence through regular hrHPV testing based on national screening guidelines. Current guidelines in the United States recommend a Papanicolaou (Pap) test every 3 years for women aged 21 years and older, with HPV cytology co-testing and primary hrHPV testing offered every 5 years as well in women aged 30 years and older.
Studies have indicated improved rates of cervical cancer screening from hrHPV self-collection kits, but data on under-screened women in the United States is lacking. To determine how hrHPV sampling kits affect cervical cancer screening prevalence in under-screened women, investigators conducted a randomized clinical trial.
There were 665 under-screened women in the trial across 22 North Carolina counties. Recruitment was performed through radio and print advertisements, a social assistance helpline, online posting, and community events and organizations. Participants were of racial and ethnic diversity, with a mean age of 42 years.
Of participants, 55% self-reported as Black or Hispanic, 78% uninsured, and 57% unemployed. Inclusion criteria included having not received a Pap test in at least 4 years or an hrHPV test in at least 6 years.
Participants were either given help making an in-person appointment or given help alongside hrHPV self-collection kits. Cervical screening uptake after 6 months of enrollment was the primary outcome of the study, measured through a negative hrHPV test result or attendance of an in-person appointment.
Cervical cancer screening rates were 72% in participants given hrHPV self-collection kits and help scheduling an appointment compared to 37% in participants only given help scheduling. Participants’ age, time since last screening, race and ethnicity, education level, and insurance status did not impact these outcomes.
A sample was returned by 78% of participants who received hrHPV self-collection kits. Results were returned to 329 participants, 16% of which received a positive result and were referred to a follow-up appointment. Of these participants, 42% attended the follow-up, where further tests were conducted to identify potential CIN2+ lesions.
Study limitations include recruiting women who do not regularly use clinic services, hrHPV kits not meeting all the needs of every under-screened woman, in-clinic attendance being seen in under half of positive cases, and the trial occurring in a prepandemic period, leading to a lack of data on how the pandemic affected screening uptake.
“Our findings suggest programs that use mailed HPV kits with effective community outreach can greatly improve screening uptake among underserved, at-risk women in the USA,” said Jennifer S. Smith, PhD, lead author and professor in the Department of Epidemiology at University of North Carolina at Chapel Hill.
The second author, Noel Brewer, PhD, added that government approval of at-home HPV tests could allow doctors to reach patients in rural areas who often face challenges receiving cervical cancer screening. This could lead to life-saving preventable care.
THE LANCET PUB. HEALTH: Mailing at-home HPV sampling kits nearly doubles cervical screening uptake among hard-to-reach populations, US clinical trial suggests. The Lancet. May 11, 2023. Accessed May 12, 2023. https://www.eurekalert.org/news-releases/988813