PT  - JOURNAL ARTICLE
AU  - Rebecca Landy
AU  - Tony Hollingworth
AU  - Jo Waller
AU  - Laura A.V. Marlow
AU  - Jane Rigney
AU  - Thomas Round
AU  - Peter Sasieni
AU  - Anita Wey Wey Lim
TI  - Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial
AID  - 10.3399/BJGP.2021.0350
DP  - 2021 Oct 28
TA  - British Journal of General Practice
PG  - BJGP.2021.0350
4099  - http://bjgp.org/content/early/2021/10/28/BJGP.2021.0350.short
4100  - http://bjgp.org/content/early/2021/10/28/BJGP.2021.0350.full
AB  - 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.