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HPV self‐sampling or the Pap‐smear: A randomized study among cervical screening nonattenders from lower socioeconomic groups in France
Author(s) -
SanchoGarnier H.,
Tamalet C.,
Halfon P.,
Leandri F.X.,
Retraite L. Le,
Djoufelkit K.,
Heid P.,
Davies P.,
Piana L.
Publication year - 2013
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.28283
Subject(s) - medicine , papanicolaou stain , cervical cancer , gynecology , randomization , socioeconomic status , papanicolaou test , obstetrics , randomized controlled trial , cervical cancer screening , cervical screening , sampling (signal processing) , demography , cancer , population , environmental health , filter (signal processing) , sociology , computer science , computer vision
Today in France, low attendance to cervical screening by Papanicolaou cytology (Pap‐smear) is a major contributor to the 3,000 new cervical cancer cases and 1,000 deaths that occur from this disease every year. Nonattenders are mostly from lower socioeconomic groups and testing of self‐obtained samples for high‐risk Human Papilloma virus (HPV) types has been proposed as a method to increase screening participation in these groups. In 2011, we conducted a randomized study of women aged 35–69 from very low‐income populations around Marseille who had not responded to an initial invitation for a free Pap‐smear. After randomization, one group received a second invitation for a free Pap‐smear and the other group was offered a free self‐sampling kit for HPV testing. Participation rates were significantly different between the two groups with only 2.0% of women attending for a Pap‐smear while 18.3% of women returned a self‐sample for HPV testing ( p ≤ 0.001). The detection rate of high‐grade lesions (≥CIN2) was 0.2‰ in the Pap‐smear group and 1.25‰ in the self‐sampling group ( p = 0.01). Offering self‐sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions (≥CIN2) in comparison to the group of women receiving a second invitation for a Pap‐smear. However, low compliance to follow‐up in the self‐sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.