Cervical cancer remains a significant clinical challenge globally, as evidenced by over 600,000 new diagnoses and over 300,000 deaths in 2020. In the past few decades, cervical cancer rates have declined in the United States due to widely implemented screening programs.
The American College of Obstetricians and Gynecologists (ACOG) recommends women receive Pap smears every three years for women aged 21 to 29. Regular human papillomavirus (HPV) testing can replace Pap smears for women aged 30 to 65. The Centers for Disease Control (CDC) reports that only 66% of women 18 or older have had a Pap smear in the past three years.
In 2020, the US had about 11,000 cases of cervical cancer and about 4,000 deaths. While cervical cancer rates in the US may appear lower compared to global trends, research has documented significant racial disparities. Around half of cervical cancer cases occur in women out of compliance with screening guidelines, and early detection of cervical cancer has a remarkable impact on long-term outcomes. Thus, increases in screening adherence could have significant benefits. Healthcare providers have tried actively thinking out of the box to find new methods to encourage cervical cancer screening. Labroots recently covered a study that employed TikTok videos!
A recent Journal of the American Medical Association report evaluated a novel strategy to improve screening compliance by mailing self-administered HPV testing kits to women. The study compared the effectiveness of this approach in women currently due for screening and those overdue for screening. The researchers identified women aged 30 to 64 who have not undergone a hysterectomy.
The researchers randomly assigned women to one of four testing groups. Some women received regular reminders from their clinician (“usual care”), while a second group received the standard reminders supplemented with educational materials about cervical cancer screening (“education”). A third group of women received regular clinician reminders and educational materials, and, in addition, the researchers mailed an HPV self-sampling kit to this group (“direct mail”). Finally, the fourth group of women received an option to request a self-sampling kit in addition to standard reminders and education (“opt-in”).
Among women due for screening, compliance increased in the direct mail group (14.1%) and the opt-in group (3.5%) compared to the education group. When evaluating the data for women overdue for screening, the researchers found women in the direct mail group were 16.9% more likely to complete screening than those in the education group. Women with an unknown screening history appeared 2.2% higher in the opt-in group than in the education group.
Overall, while the opt-in approach slightly benefited screening compliance, mailing self-sampling kits to women increased compliance to cervical cancer screening guidelines in individuals due or overdue for screening. The authors suggest that healthcare systems motivated to improve screening adherence should consider mailing self-screening kits to women, mainly those overdue for screening or who may experience difficulty obtaining in-office screening examinations.
Sources: J Nat Cancer Inst, Am J Prev Med, JAMA, Health Communication
