Posted cervical screening kits a winner

A clinical trial in the United States ‘sets a new bar’ for cervical screening, an Australian expert says, after it showed screening rates more than doubled in people who were mailed self-collection kits and given phone support.
 
GP and women’s health expert, Associate Professor Magda Simonis, said the recently published trial showed ‘positive indications’ of the potential benefits when additional support is given to marginalised people – who historically remained under-screened.
 
‘Given that Australia is so vast and so diverse, there’s so many different cultural groups, this … sets a new bar in how we run screening programs and how we can capture more of those lesser-screened individuals,’ she told newsGP.
 
Conducted by the University of Texas MD Anderson Cancer Center, the randomised clinical trial involved 2474 people in Houston, Texas, who were overdue for cervical cancer screening.
 
Of the participants, 94% were from racial or ethnic marginalised populations, including Hispanic Latino, non-Hispanic Asian, African American and American Indian.
 
And of those, more than half (56.1%) were covered by their county's publicly funded financial assistance program. 
 
The participants were put into three groups. The first received only telephone reminders for clinic-based cervical screening, while the second group received a telephone reminder and a self-collection kit in the mail.
 
The third group received a telephone reminder, a self-collection kit in the mail and a ‘patient navigation’ telephone call.
 
After six months, cervical screening had been undertaken by 17.4% of the group who received only telephone reminders.

However, among those who received as telephone reminder and self-screening kit in the mail, 41.1% had completed a cervical screening – 2.6 times higher than in the first group.
 
The third group, which also received patient navigation calls, showed a slightly higher uptake again, of 46.6%, or 2.68 times higher than the first group.
 
From July 2022, Australia’s National Cervical Screening Program (NCSP) expanded its screening processes to include self-collection for all eligible women and people born with a cervix, in an attempt to reach populations that remained under-screened due to reasons such as cultural sensitivity, language barriers, socio-economic disadvantage or geographic isolation.
 
However, many eligible people are still missing out on screening. Associate Professor Simonis believes such measures used in the US trial, and a ‘customised’ approach for different communities, could help change that.
 
‘People who are marginalised, linguistically diverse and rural and remote, when they don’t have that much contact with the health sector, only on an as-needs basis, screening doesn’t rate as highly as a concept, because they might not receive the same sort of level of information around it, and not necessarily in their language,’ said Associate Professor Simonis.
 
‘I think for Indigenous [Australian] communities, there’s a lot of mystery around what the cervical screening test is, so perhaps having leaders from within their community talking to them about it and following up on it too would be better.
 
‘It does need to be customised to the cultural group that we’re trying to reach.
 
‘Because statistically, even with all our very well-established programs, the further away you get from metropolitan areas and the further away you get from the English language being the first language, the less likely you are to be screened.’
 
Associate Professor Simonis said even with self-collection available, GPs still have a role to play in cervical screening, especially with older women, and particularly those from non-English speaking backgrounds who still have ‘resistance’ to self-screening.
 
‘Having that conversation with them and giving them the option does require some guided counselling,’ she said.
 
‘I’ve found a good proportion will take the opportunity, but some will still insist on having the doctor do it.
 
‘If this kind of program is implemented with the learnings, as we’re understanding more and more about human psychology and resistance to self-testing, and you provide women with support to take the tests, this is really, really important information.’
 
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