Hallik Reeli, Innos Kaire, Jänes Jaak, Jõers Kai, Ratnik Kaspar, Veerus Piret
Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
J Med Screen. 2025 Mar;32(1):19-27. doi: 10.1177/09691413241268819. Epub 2024 Aug 1.
Cervical cancer incidence in Estonia ranks among the highest in Europe, but screening attendance has remained low. This randomized study aimed to evaluate the impact of opt-in and opt-out human papillomavirus (HPV) self-sampling options on participation in organized screening.
A random sample of 25,591 women were drawn from the cervical cancer screening target population who were due to receive a reminder in autumn 2021 and thereafter randomly allocated to two equally sized intervention arms (opt-out and opt-in) receiving a choice between HPV self-sampling or clinician sampling. In the opt-out arm, a self-sampler was sent to home address by regular mail; the opt-in arm received an e-mail containing a link to order a self-sampler online. The remaining 30,102 women in the control group received a standard reminder for conventional screening. Participation by intervention arm, age and region of residence was calculated; a questionnaire was used to assess self-sampling user experience.
A significant difference in participation was seen between opt-out (41.7%) (19.8% chose self-sampling and 21.9% clinician sampling), opt-in (34.1%) (7.9% self-sampling, 26.2% clinician sampling) and control group (29.0%, clinician sampling only). All age groups and regions in the intervention arms showed higher participation compared to the control group, but the size of the effect varied. Among self-sampling users, 99% agreed that the device was easy to use and only 3.5% preferred future testing at the clinic.
Providing women with a choice between self-sampling and clinician sampling significantly increased participation in cervical cancer screening. Opt-in and opt-out options had a different effect across age groups, suggesting the need to adapt strategies.
爱沙尼亚的宫颈癌发病率在欧洲名列前茅，但筛查参与率一直很低。这项随机研究旨在评估主动选择和被动选择的人乳头瘤病毒（HPV）自我采样选项对参与组织筛查的影响。
从宫颈癌筛查目标人群中随机抽取25591名女性样本，这些女性将于2021年秋季收到提醒，之后被随机分配到两个规模相等的干预组（被动选择组和主动选择组），她们可以在HPV自我采样或临床医生采样之间做出选择。在被动选择组中，通过普通邮件将自我采样器寄到家庭住址；主动选择组收到一封电子邮件，其中包含在线订购自我采样器的链接。对照组的其余30102名女性收到传统筛查的标准提醒。计算干预组、年龄和居住地区的参与率；使用问卷评估自我采样的用户体验。
被动选择组（41.7%）（19.8%选择自我采样，21.9%选择临床医生采样）、主动选择组（34.1%）（7.9%自我采样，26.2%临床医生采样）和对照组（29.0%，仅临床医生采样）之间的参与率存在显著差异。与对照组相比，干预组的所有年龄组和地区的参与率都更高，但效果大小有所不同。在自我采样用户中，99%的人认为该设备易于使用，只有3.5%的人更喜欢未来在诊所进行检测。
为女性提供自我采样和临床医生采样之间的选择显著提高了宫颈癌筛查的参与率。主动选择和被动选择选项在不同年龄组中有不同的效果，这表明需要调整策略。
