JAMA

Does mailing HPV self-sampling kits increase cervical cancer screening rates?

December 1, 2023

In this randomized clinical trial of individuals at Kaiser Permanente Washington, direct-mailing of HPV self-sampling kits increased cervical cancer screening by more than 14% in individuals who were due or overdue for screening. The opt-in approach minimally increased screening.

• The Self-Testing options in the Era of Primary HPV screening for cervical cancer (STEP) trial included 31,355 randomized individuals of female sex between the age of 30 to 64 years (mean age, 45.9 years).
• Individuals who were stratified as due for screening were randomized to receive usual care (patient reminders, clinician EHR alerts [n=3,671]), education (usual care plus educational materials about screening [n=3,960]), direct mail (usual care, educational materials about screening, and a mailed self-sampling kit [n=1,482]), or to opt in (usual care plus educational materials and the option to request a kit [n=3,956]).
• Those who were overdue for screening were randomized to receive usual care (n=5,488), education (n=1,408), or direct mail (n=1,415).
• Those with unknown history were randomized to receive usual care (n=2,983), education (n=3,486), or to opt in (n= 3,506).
• Among those who were due for screening, compared with receiving education alone, screening completion was 14.1% higher in the direct-mail group and 3.5% higher in the opt-in group.
• Among individuals who were overdue, screening completion was 16.9% higher in the direct-mail group compared with education alone.
• Among those with unknown history, screening was 2.2% higher in the opt-in group compared with education alone.
• To further increase screening adherence, health care systems implementing HPV self-sampling should prioritize direct-mail outreach for individuals who are due or overdue for screening. For individuals with unknown screening history, testing alternative outreach approaches and additional efforts to document screening history are warranted.

Source:

Winer RL, et al. (2023, November 28). JAMA. Strategies to increase cervical cancer screening with mailed human papillomavirus self-sampling kits: a randomized clinical trial. https://pubmed.ncbi.nlm.nih.gov/38015219/