@article {LandyBJGP.2021.0350, author = {Rebecca Landy and Tony Hollingworth and Jo Waller and Laura A.V. Marlow and Jane Rigney and Thomas Round and Peter Sasieni and Anita Wey Wey Lim}, title = {Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial}, elocation-id = {BJGP.2021.0350}, year = {2021}, doi = {10.3399/BJGP.2021.0350}, publisher = {Royal College of General Practitioners}, abstract = {Background: Cervical cancer disproportionately affects women aged 65 years and older, especially those with inadequate previous screening. Speculum use is a key deterrent to screening attendance in older women. Aim: To assess whether offering non-speculum clinician-taken sampling and self-sampling increase uptake among lapsed attenders aged 50-64. Design and setting: Pragmatic randomised control trial conducted between August 2018 and November 2019 at 10 general practices in East London, UK. Method: Participants were 784 women aged 50-64 last screened 6-15years before randomisation. Intervention women received a letter offering the choice of a self-sampling kit or a clinician-taken non-speculum sample. Control women received usual care. Main outcome measure: uptake within 4 months. Results: Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4\% (N=80/393) vs 4.9\% (N=19/391, absolute difference=15.5\%, 95\%CI: 11.0\%-20.0\%, p\<0.001). This was maintained at 12 months; 30.5\% (N=120/393) vs 13.6\% (N=53/391), respectively (absolute difference=17.0\%, 95\%CI: 11.3\%-22.7\%, p\<0.001). Conventional screening attendance within 12 months was very similar for both arms (intervention: 12.7\% (N=50/393) vs control: 13.6\% (N=53/391)). Ethnic differences were observed in screening modality preference. More white women opted for self-sampling (50.7\%, N=38/75) while most Asian and Black women opted for conventional screening. Conclusions: Offering non-speculum clinician-sampling and self-sampling substantially increases uptake in older women with lapsed screening attendance. Non-speculum clinician sampling appeals to women who dislike the speculum but prefer a clinician to take their sample and who lack confidence in self-sampling. Providing a choice of screening modality may be important for optimising cervical screening uptake.}, issn = {0960-1643}, URL = {https://bjgp.org/content/early/2021/10/28/BJGP.2021.0350}, eprint = {https://bjgp.org/content/early/2021/10/28/BJGP.2021.0350.full.pdf}, journal = {British Journal of General Practice} }