Abstract 4135: Improving attendance to the cervical cancer screening program: Does self-sampling at home improve cervical cancer prevention
Authors: Schee Kristina , Stefan Lönnberg , Pedersen Helle , Bonde Jesper , Nygård Mari 
Published: May 2015

Abstract
With over half a million new cases and 275,000 deaths each year, cervical cancer constitutes a major public health problem world-wide, ranking as the third most common cancer in women. Screening with Pap-smear has reduced cervical cancer related morbidity and mortality considerably. However, the challenge lies in making screening and treatment available to all women at risk.
Main objective of this study was to evaluate performance of high-risk human papillomavirus (hrHPV) testing on self-collected smears by women who did not attend to screening regularly. Specifically we were interested to observe if: i) use of different self-sampling devices for hrHPV was feasible in Norway and ii) will self-sampling enhance attendance among women with suboptimal screening? iii) which HPV test should be used to ensure optimal follow-up?
Following approval from the Regional Ethical Committee, we identified in Oslo, Norway, during April-May 2013, 3,393 women with sub-optimal screening history. To motivate screening attendance, two different interventions were randomly allocated: 1) 300 women in age 26-34 and 300 women in age of 35-49 years, and 200 women in age of 50-69 years, received either lavage based self-screener (Delphi ScreenerTM, Delphi Bioscience BV) or dry brush self-screener (Evalyn Brush®, Rovers, The Netherlands); 2) 2,593 received a routine reminder letter to make an appointment for a Pap-smear. Those, who returned self-sampling devices or who had screening smear taken in 6 months period were defined as attendees. The population-based screening registry was used to identify those who had a screening smear.
Returned self-sampling devices were tested for hrHPV by Hybrid Capture2 (HC2) High-Risk HPV DNA Test® (QIAGEN, Gaithersburg, MD, USA) and HPV genotyped (CLART, Genomica, Madrid, Spain).
Out of 800, 80 women declined to participate in the self-sampling study and 720 devices was mailed out; 168 (23.3%) self-sampling devices were returned, 88 dry brush and 80 lavage-based self-sampling devices; in addition 59 had a Pap-smear (8.2%). 388 (14.7%) out of 2,593 who received a letter had a Pap-smear.
Overall hrHPV positivity rate, defined as positive either by CLART or HC2, was over 20% being highest in 26-34 years old (&gt;30% ) and lowest in 50-69 years old (&lt;15%). Only 13% were positive for both methods illustrating challenges in choosing HPV detection method when using self-sampling (preliminary results, based on 5-months follow-up).
The preliminary results show 31.5% participation for self-sampling group compared to 14.7% participation for the routine, reminder letter group.
Preliminary results indicate that i) it is feasible to use self-sampling device in routine screening; ii) use of self-sampling improves overall attendance of the screening program; iii) comparison of two different hrHPV detection methods will be presented in the conference.
Citation Format: Kristina Schee, Lönnberg Stefan, Helle Pedersen, Jesper Bonde, Mari Nygård. Improving attendance to the cervical cancer screening program: Does self-sampling at home improve cervical cancer prevention. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4135. doi:10.1158/1538-7445.AM2014-4135