RT Journal Article
SR Electronic
T1 Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP BJGP.2021.0350
DO 10.3399/BJGP.2021.0350
A1 Rebecca Landy
A1 Tony Hollingworth
A1 Jo Waller
A1 Laura A.V. Marlow
A1 Jane Rigney
A1 Thomas Round
A1 Peter Sasieni
A1 Anita Wey Wey Lim
YR 2021
UL http://bjgp.org/content/early/2021/10/28/BJGP.2021.0350.abstract
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.