Speculum-free sampling increases cervical cancer screening uptake in middle-aged women

Non-speculum sampling by clinicians and self-sampling “substantially increased” cervical cancer screening uptake in women aged 50 to 64 years who were overdue for screening, according to researchers.

The American Cancer Society predicted that nearly 15,000 new cases of invasive cervical cancer would be diagnosed in the U.S. in 2021, and that the average age at diagnosis for the disease is 50 years. CDC researchers have previously reported that the percentages of U.S. women who have never had a Pap test or have not had one within the last 5 years are 11.7% among those aged 46 to 50 years, 11.3% among those aged 51 to 55 years, 17.1% among those aged 56 to 60 years, 18.4% among those aged 61 to 65 years and 23.6% among those aged 66 to 70 years.

“Over one-third of cervical cancer deaths occur at ages 65 and older in the U.S.,” Rebecca Landy, PhD, a postdoctoral fellow in the division of cancer epidemiology and genetics at the National Cancer Institute, told Healio. “We know that cervical screening is very effective at preventing cervical cancer, but that screening rates are lower at older ages, in part because current screening methods (with a speculum) can become particularly uncomfortable for women after menopause.”

One solution to screening is self-sampling, “but many women worry they have not taken the sample correctly,” Landy said.

“Offering a clinician-collected sample without the use of a speculum may appeal to these women; this is the first study to try this,” Landy said in the interview.

Landy and colleagues conducted a randomized controlled trial of 784 women who attended one of 10 clinics in the United Kingdom. All of the women were aged 50 to 64 years, and the majority were white. It had been between 6 and 15 years since the participants’ last cervical cancer screening.

The women were randomly assigned in an approximate 1:1 ratio to receive the intervention or usual care. The intervention consisted of a letter inviting the women to participate in the study, either by booking an appointment at their clinic for a non-speculum screening or ordering a kit to collect their own sample. For those who participated in self-sampling, the women collected the sample using a vaginal swab or brush and used a prepaid envelop to submit the sample, according to the researchers.

Women in the usual care cohort were offered cervical screening every 5 years until they reached 64 years of age and remained eligible for screening in between invitations if they were overdue. The clinics that participated in the study were asked to make it easy for women to book screening appointments, Landy and colleagues wrote in the British Journal of General Practice.

The researchers reported that 4 months after the women had been randomized, cervical cancer screening uptake was significantly higher in the intervention cohort than the usual care cohort (20.4% vs. 4.9%; absolute difference = 15.5%, 95% CI, 11-20). The increase between the two cohorts was maintained at 12 months (30.5% vs. 13.6%; absolute difference = 17%, 95% CI, 11.3- 22.7).

In addition, the women’s attendance for cervical cancer screening via a speculum within 12 months was “very similar” for both cohorts (12.7% vs. 13.6%). Half of white women chose self-sampling, and most women who were Asian (53.3%), Black (71.4%) or from other underrepresented groups (66.7%) chose speculum screening.

“Neither self-sampling nor non-speculum sample are currently approved by the FDA, so they cannot be offered to women yet, but this study suggests that alternative collection methods may increase the proportion of lapsed patients who are screened,” Landy said.

The American Cancer Society encourages cervical cancer screening via only an HPV test every 5 years for every woman with a cervix from age 25 years until age 65 years. If HPV testing alone is not available, these women should be screened with an HPV/Pap cotest every 5 years or a Pap test every 3 years. After 65 years of age, and if all previous tests were normal, screening can stop. The U.S. Preventive Services Task Force currently recommends against screening for cervical cancer in women older than 65 years old if they have had adequate prior screening and are not otherwise at high risk for cervical cancer.

References:

ACS’s updated cervical cancer screening guidelines explained. https://www.cancer.gov/news-events/cancer-currents-blog/2020/cervical-cancer-screening-hpv-test-guideline. Accessed Jan. 7, 2022.

Key statistics for cervical cancer. https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html. Accessed Jan. 7, 2022.

Landy R, et al. Br J Gen Pract. 2021;doi:10.3399/BJGP.2021.035.

White MC, et al. Am J Prev Med. 2017;doi: 10.1016/j.amepre.2017.02.024.