Increased screening uptake is observed with mailed self-sampling kits by all sub-groups. Differences in effectiveness according to patient characteristics highlight opportunities to optimize self-sampling for priority groups.
Human papillomavirus (HPV)-only is a cervical cancer screening method that is more sensitive than Papanicolaou (Pap) cytology-based testing. It has the further advantage of allowing individuals to collect samples themselves. US healthcare systems are beginning to incorporate self-sampling to increase screening rates. Home-Based Options to Make Cervical Cancer Screening Easy (HOME) was the first trial that evaluated the effectiveness of mailed HPV self-sampling kits in a US healthcare system.
Increased screening rates were observed with this method compared with usual care reminders and outreach. However, nearly three-quarters of women in the self-sampling intervention group did not screen. Secondary data analysis was performed based on HOME trial data to identify which patient characteristics modified the mailed kit intervention’s effectiveness. The analysis was published in the JAMA Network Open.
The total number of eligible participants for this secondary analysis was 19,734. Of these, 9843 were in the intervention group and 9891 in the control group. The mean age was 50.1 years and 71.6% of individuals were White. Baseline characteristics were similar between the groups.
Greater Uptake Occurred in Women With Longer Duration Since Last Screening
Screening uptake in the intervention group was higher than in the control group (26.3% vs 17.4%, respectively). Within the intervention group, relative increases in screening uptake were greater with longer vs. shorter duration since the last screening and were highest in women with no prior screening. Conversely, absolute differences varied little by screening history.
Age, Race, and Prior Screenings Affect Sampling Methods
Multiple factors, such as age, race, duration of enrollment, and time since the last screening, influenced the choice of screening modality. In the intervention group, women without prior screening were more likely to screen by self-sampling vs. in-clinic sampling. The relative intervention effect was higher in those overdue vs. up-to-date with mammography. However, the absolute difference was greater in the up-to-date vs. overdue group.
Older Women More Likely to Use Home Kits
A difference in intervention effect by age was observed, with the highest relative and absolute increases in screening in the oldest women, although the differences were not statistically significant. Moreover, compared to younger subjects, older women in the intervention group were significantly more likely to screen by kit vs. in-clinic.
Disparities in Uptake of Self-Sampling
Self-sampling uptake was highest in White participants and lowest in Native Hawaiian/other Pacific Islander and American Indian/Alaskan Native participants.
Intervention Outcomes and BMI, Tobacco Use, and Comorbidities
Effectiveness within the intervention group did not differ by BMI, tobacco use, or comorbidities.
These results highlight target areas for interventions to reduce cervical cancer underscreening in difficult-to-reach individuals.
Winer, R. L., Lin, J., Tiro, J. A., Miglioretti, D. L., Beatty, T. J., Gao, H., Kimbel, K., Thayer, C., & Buist, D. S. M. (2022). Effect of Patient Characteristics on Uptake of Screening Using a Mailed Human Papillomavirus Self-sampling Kit. JAMA Network Open, 5(11), e2244343. https://doi.org/10.1001/jamanetworkopen.2022.44343