Effect of direct mailing self-sampling kits on participation in the Dutch hrHPV-based cervical screening programme: a population-based study.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 41847601.
- Also identified by DOI 10.1016/j.lanepe.2026.101635 and PMC identifier 12990366.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
In July 2023, the Dutch cervical cancer screening programme introduced direct mailing of self-sampling kits with invitations for 30-year-olds and with reminder for non-participants in other age groups after 12 weeks. This study evaluates the impact of this new policy on participation, self-sampling uptake, and follow-up testing. Data from the national screening (ScreenIT) and pathology (Palga) databases were used. Individuals invited between July 11 and December 31, 2023, were compared to a control group from the same period in 2022. Primary outcomes included participation rates following invitation and reminder, time to participation, self-sampling uptake, reflex cytology participation among high-risk HPV(hrHPV)-positive self-sampling participants, and first-time participation. Analyses were stratified by age and screening history. Overall participation increased from 42.1% (n = 330,413) in the control group to 49.9% (n = 327,376; RR: 1.19, 95% CI: 1.18-1.19) with the new policy. After primary invitation, the largest increase in participation from 30.6% to 40.3% was observed among 30-year-olds (RR: 1.32, 95% CI: 1.30-1.34). Vaginal self-sampling uptake increased from 21.9% to 61.9% (RR: 2.82, 95% CI: 2.79-2.85), with the largest uptake among first-time participants (previous non-attenders, 32.1%-78.1%; RR: 2.43, 95% CI: 2.35-2.51) and 30-34-year-olds (25.1%-83.7%; RR: 3.33, 95% CI: 2.25-3.40). The proportion of first-time participants increased from 6.8% in the control group to 9.1% with the new policy. Participation increased sharply in individuals aged 35+ after 12 weeks. Reflex cytology participation among hrHPV-positive self-sampling participants declined by 6% (from 93% to 87%; RR: 0.94, 95% CI: 0.93-0.95), but this did not affect the overall increase in participation rates. Direct mailing of self-sampling kits is an effective strategy to increase participation in population-based cervical cancer screening programmes, especially among first-time invitees and previous non-attenders. Continued participation in reflex cytology among hrHPV-positive women remains essential to maximise the overall impact of the policy on screening effectiveness. This study was funded by the National Institute for Public Health and the Environment.