Mass Screening Registry, Finnish Cancer Registry, Pieni Roobertinkatu 9, FI-00130 Helsinki, Finland.
Cancer Epidemiol Biomarkers Prev. 2011 Sep;20(9):1960-9. doi: 10.1158/1055-9965.EPI-11-0307. Epub 2011 Jul 13.
Attendance in screening is an important determinant of cervical cancer. Previous experience on high-risk human papillomavirus (hrHPV) DNA testing on patient-obtained samples suggests a good effect among nonattendees of screening. We assessed the effects of self-sampling on attendance in the Finnish screening program.
Nonattendees after the primary invitation in one municipality (Espoo) were randomized to receive either a self-sampling kit (2,397 women) or an extra invitation (6,302 women). One fourth (1,315 women) of reminder letter arm nonattendees also received a self-sampling kit as a third intervention. Main outcomes were increases in screening attendance and coverage.
The adjusted relative risk for participation by self-sampling as a second intervention in comparison to a reminder letter arm was 1.21 (95% CI: 1.13-1.30). Total attendance increased from 65% to 76% by self-sampling and from 65% to 74% with a reminder letter. Combining the interventions (reminder letter and then self-sampling) increased total attendance from 63% to 78%. One fifth of the participants in all three groups increased screening coverage (previous Pap smear ≥5 years ago or never). Self-obtained samples were more often HPV positive than provider-obtained ones (participants after primary invitation and reminder letter), 12% to 13% versus 7%.
Self-sampling is a feasible option in enhancing the attendance at organized screening, particularly as an addition to a reminder letter.
If self-sampling is used as a third intervention after two written invitations, the overall attendance in Finland could most likely reach the desired 80% to 85%.
筛查参与率是宫颈癌的一个重要决定因素。既往关于患者自采样高危型人乳头瘤病毒（hrHPV）DNA 检测的经验表明，该方法对筛查未参与者有较好的效果。本研究评估了自采样对芬兰筛查计划参与率的影响。
在一个市（埃斯波），对初次邀请后未参加筛查的人群进行随机分组，一组接受自采样试剂盒（2397 名女性），另一组接受额外邀请（6302 名女性）。四分之一（1315 名）的提醒信组未参与者也作为第三次干预措施接受了自采样试剂盒。主要结局是筛查参与率和覆盖率的增加。
与提醒信组相比，作为第二次干预措施的自采样的调整后参与率相对风险为 1.21（95%CI：1.13-1.30）。自采样组的总参与率从 65%增加到 76%，而提醒信组的总参与率从 65%增加到 74%。将两种干预措施（提醒信后再自采样）结合起来，总参与率从 63%增加到 78%。所有三组中都有五分之一的参与者增加了筛查覆盖率（之前巴氏涂片检查≥5 年或从未进行过巴氏涂片检查）。与医务人员获取样本相比，自采样样本的 HPV 阳性率更高（初次邀请和提醒信后组），为 12%至 13%，而医务人员获取样本的 HPV 阳性率为 7%。
自采样是提高有组织筛查参与率的可行选择，尤其是作为提醒信的补充。
如果在两次书面邀请后使用自采样作为第三次干预措施，芬兰的总体参与率很可能达到 80%至 85%的目标。
