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

Background
Cervical cancer disproportionately affects women aged 65 years and older, especially those with inadequate previous screening. Speculum use is a key deterrent to screening attendance
in older women.
Aim
To assess whether offering non-speculum clinician-taken sampling and self-sampling increase uptake among lapsed attenders aged 50-64.
Design and setting
Pragmatic randomised control trial conducted between August 2018 and November 2019 at 10 general practices in East London, UK.
Method
Participants were 784 women aged 50-64 last screened 6-15years before randomisation.
Intervention women received a letter offering the choice of a self-sampling kit or a clinician taken non-speculum sample. Control women received usual care. Main outcome measure: uptake within 4 months.
Results
Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (N=80/393) vs 4.9% (N=19/391, absolute difference=15.5%, 95%CI: 11.0%-20.0%, p<0.001). This was maintained at 12 months; 30.5% (N=120/393) vs 13.6% (N=53/391), respectively (absolute difference=17.0%, 95%CI: 11.3%-22.7%, p<0.001).
Conventional screening attendance within 12 months was very similar for both arms (intervention: 12.7% (N=50/393) vs control: 13.6% (N=53/391)). Ethnic differences were observed in screening modality preference. More white women opted for self-sampling (50.7%, N=38/75) while most Asian and Black women opted for conventional screening.

Conclusions
Offering non-speculum clinician-sampling and self-sampling substantially increases uptake in older women with lapsed screening attendance. Non-speculum clinician sampling appeals to women who dislike the speculum but prefer a clinician to take their sample and who lack confidence in self-sampling. Providing a choice of screening modality may be important for optimising cervical screening uptake.