Invasive cervical cancer (ICC) is a cancer of disparities, with higher incidence and mortality rates among black women as compared to white women and Hispanic women as compared to Non-Hispanic women in the U.S. Early detection and treatment of cervical precancerous lesions can dramatically reduce the incidence of ICC, but cervical cancer screening coverage is inadequate. Insufficient screening is the largest factor in reducing ICC: an estimated 56% of incident ICC in the U.S. is due to insufficient screening, 32% to detection failure, and 13% to follow-up failure (1). Low socioeconomic status is associated with lower screening rates and may limit a woman’s ability to access preventive care due to resource-related barriers. The Affordable Care Act (2010), has the potential to increase cervical cancer screening rates by expanding insurance coverage and requiring provision of free screening services. However, Medicaid expansion has not been implemented in all states, and only an estimated 63% of Medicaid-eligible adults participate in Medicaid.
At-home HPV self-collection has the potential to increase cervical cancer screening completion among under- and never-screened women. HPV self-collection is a technique by which a woman uses a simple collection brush to obtain cervico-vaginal cell samples to test for infection with high-risk HPV infection, an objective indicator of elevated risk for cervical cancer. Self-collection for HPV testing compares favorably in sensitivity and specificity to that of physician-collection for the detection of HPV infection and high-grade cervical lesions. Only one U.S. study has evaluated the effect of at-home HPV self-collection on screening uptake, distributing kits door-to-door through community-based recruitment (2). Several European studies have found that offering at-home HPV self-collection to under- and never-screened women via direct mailing leads to higher screening completion compared to mailed invitations for in-clinic screening (e.g. 30.8% via self-collection vs. 6.5% via reminders in the Netherlands, p<0.001) (3). These studies found relatively high rates of follow-up for in-clinic Pap testing among women receiving HPV positive self-collection results (e.g. 86% in a Dutch study) (4), and that use of at-home HPV self-collection kits led to higher detection of CIN2+ than mailed written reminders alone.
Our My Body My Test studies in North Carolina show that at-home HPV self-collection kits delivered via mail are highly acceptable to under-screened, low-income women (69% to 85% return rates), consistent with high HPV self-collection acceptability demonstrated in other states and countries.
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[1. Leyden WA et al. JNCI. 2005;97(9):675-83.]
[2. Castle PE et al. Prev Med. 2011;52(6):452-5.]
[3. Gök M, et al. Int J Cancer. 2012;130(5):1128-35.]
[4. Bais AG et al. Int J Cancer. 2007;120(7):1505-10.]