Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial.

Abstract

Cervical cancer disproportionately affects women ≥65 years, especially those not screened regularly. Speculum use is a key barrier. To assess if offering non-speculum clinician-taken sampling and self-sampling increases uptake for lapsed attenders aged 50-64 years. Pragmatic randomised control trial conducted at 10 general practices in East London, UK. Participants were 784 women aged 50-64 years, last screened 6-15 years before randomisation. Intervention participants received a letter offering the choice of non-speculum clinician- or self-sampling. Control participants received usual care. The main outcome measure was uptake within 4 months. Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (<i>n</i> = 80/393) versus 4.9% in the control arm (<i>n</i> = 19/391, absolute difference 15.5%, 95% confidence interval [CI] = 11.0% to 20.0%, <i>P</i><0.001). This was maintained at 12 months: intervention 30.5% (<i>n</i> = 120/393) versus control 13.6% (<i>n</i> = 53/391) (absolute difference 17.0%, 95% CI = 11.3% to 22.7%, <i>P</i><0.001). Conventional screening attendance within 12 months was very similar for both intervention 12.7% (<i>n</i> = 50/393) and control 13.6% (<i>n</i> = 53/391) arms. Ethnic differences were seen in screening modality preference. More White women opted for self-sampling (50.7%, <i>n</i> = 38/75), whereas most Asian and Black women and those from other ethnic backgrounds opted for conventional screening. Offering non-speculum clinician-taken sampling and self-sampling substantially increases uptake in older lapsed attendee women. Non-speculum clinician sampling appeals to women who dislike the speculum but still prefer a clinician to take their sample. Providing a choice of screening modality may be important for optimising cervical screening uptake.