Home - News ( United States | United Kingdom | Italy | Germany ) - Football scores

Showing content from http://www.ncbi.nlm.nih.gov/pubmed/31693128 below:

Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment: A Randomized Clinical Trial

Randomized Controlled Trial

Affiliations

• ¹ Department of Epidemiology, University of Washington, Seattle.
• ² Kaiser Permanente Washington Health Research Institute, Seattle.
• ³ Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.
• ⁴ Division of Biostatistics, Department of Public Health Sciences, University of California, Davis.
• ⁵ Kaiser Permanente Washington, Renton.

• PMID: 31693128
• PMCID: PMC6865279
• DOI: 10.1001/jamanetworkopen.2019.14729

Item in Clipboard

Randomized Controlled Trial

Rachel L Winer et al. JAMA Netw Open. 2019.

• ¹ Department of Epidemiology, University of Washington, Seattle.
• ² Kaiser Permanente Washington Health Research Institute, Seattle.
• ³ Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.
• ⁴ Division of Biostatistics, Department of Public Health Sciences, University of California, Davis.
• ⁵ Kaiser Permanente Washington, Renton.

• PMID: 31693128
• PMCID: PMC6865279
• DOI: 10.1001/jamanetworkopen.2019.14729

Item in Clipboard

Importance: In the United States, more than 50% of cervical cancers are diagnosed in underscreened women. Cervical cancer screening guidelines now include primary human papillomavirus (HPV) testing as a recommended strategy. Home-based HPV self-sampling is a viable option for increasing screening compliance and effectiveness; however, US data are needed to inform health care system implementation.

Objective: To evaluate effectiveness of mailed HPV self-sampling kits vs usual care reminders for in-clinic screening to increase detection and treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and uptake of cervical cancer screening.

Design, setting, and participants: Randomized clinical trial conducted in Kaiser Permanente Washington, a US integrated health care delivery system. Women aged 30 to 64 years with health plan enrollment for 3 years and 5 months or more, a primary care clinician, no Papanicolaou test within 3 years and 5 months, and no hysterectomy were identified through electronic medical records and enrolled from February 25, 2014, to August 29, 2016, with follow-up through February 26, 2018.

Interventions: The control group received usual care (annual patient reminders and ad hoc outreach from primary care clinics). The intervention group received usual care plus a mailed HPV self-sampling kit.

Main outcomes and measures: Two primary outcomes were (1) CIN2+ detection within 6 months of screening and (2) treatment within 6 months of CIN2+ detection. Screening uptake within 6 months of randomization was a secondary outcome.

Results: A total of 19 851 women (mean [SD] age, 50.1 [9.5] years) were included, with 9960 randomized to the intervention group and 9891 randomized to the control group. All women randomized were included in analysis. In the intervention group, 12 participants with CIN2+ were detected compared with 8 in the control group (relative risk, 1.49; 95% CI, 0.61-3.64) and 12 cases were treated vs 7 in the control group (relative risk, 1.70; 95% CI, 0.67-4.32). Screening uptake was higher in the intervention group (2618 participants [26.3%] vs 1719 participants [17.4%]; relative risk, 1.51; 95% CI, 1.43-1.60).

Conclusions and relevance: Mailing HPV kits to underscreened women increased screening uptake compared with usual care alone, with no significant differences in precancer detection or treatment. Results support the feasibility of mailing HPV kits to women who are overdue for screening as an outreach strategy to increase screening uptake in US health care systems. Efforts to increase kit uptake and follow-up of positive results are warranted to maximize detection and treatment of CIN2+.

Trial registration: ClinicalTrials.gov identifier: NCT02005510.

PubMed Disclaimer

Conflict of Interest Disclosures: Dr Winer reported receiving grants from the National Institutes of Health and Centers for Disease Control and Prevention outside the submitted work. Dr Tiro reported receiving grants from the National Institutes of Health, Lyda Hill Philanthropies, the Agency for Healthcare Research and Quality, and the Cancer Prevention & Research Institute of Texas outside the submitted work; as well as membership on the American Cancer Society's National HPV Vaccination Roundtable and attendance at St Jude's HPV Vaccine Strategy Workshop. No other disclosures were reported.

We identified 63…

We identified 63 789 women who were between the ages of…

We identified 63 789 women who were between the ages of 30 and 64 years, had not had a hysterectomy, had a primary care clinician at Kaiser Permanente Washington (KPWA), and had been continuously enrolled in the health system for at least 3 years and 5 months. Of these women, 17 256 (27.1%) had not had a Papanicolaou test within 3 years and 5 months. Postrandomization exclusions were applied owing to delays in data warehouse update. The total included in the intervention group analysis (9960) equals the total included in the round 1 analysis group (8120) plus the total included in the round 2 analysis group (1631) plus the total included in the round 3 analysis group (209). Similarly, the total included in the control group analysis (9891) equals the total included in the round 1 analysis group (8111) plus the total included in the round 2 analysis group (1585) plus the total included in the round 3 analysis group (195).

CIN2+ indicates positive results…

CIN2+ indicates positive results for cervical intraepithelial neoplasia grade 2 or higher; HPV, human papillomavirus; hrHPV, high-risk HPV; Unsat, unsatisfactory. ^aSelf-sampling other hrHPV+ only or unsatisfactory results required in-clinic follow-up to complete screening uptake. ^bOf these 20 women, 15 went directly to colposcopy and 5 went to Papanicolaou test or cotest before colposcopy. ^cThese 5 women completed screening uptake by receiving colposcopy in the 6 month screening window. ^dThis 1 woman did not complete screening uptake because colposcopy was completed outside the 6-month screening window. ^eIncludes 2 women with home kit other hrHPV+ and Papanicolaou test with unknown result. Because unknown Papanicolaou test results were coded as normal for analysis, the final result is considered other hrHPV+ and Papanicolaou test negative. One of these women received a colposcopy. ^fFollow-up recommendations were per national guidelines.

• Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening.

  Meenan RT, Troja C, Buist DSM, Tiro JA, Lin J, Anderson ML, Gao H, Green BB, Winer RL. Meenan RT, et al. JAMA Netw Open. 2023 Mar 1;6(3):e234052. doi: 10.1001/jamanetworkopen.2023.4052. JAMA Netw Open. 2023. PMID: 36947040 Free PMC article. Clinical Trial.

• Effect of Patient Characteristics on Uptake of Screening Using a Mailed Human Papillomavirus Self-sampling Kit: A Secondary Analysis of a Randomized Clinical Trial.

  Winer RL, Lin J, Tiro JA, Miglioretti DL, Beatty T, Gao H, Kimbel K, Thayer C, Buist DSM. Winer RL, et al. JAMA Netw Open. 2022 Nov 1;5(11):e2244343. doi: 10.1001/jamanetworkopen.2022.44343. JAMA Netw Open. 2022. PMID: 36449291 Free PMC article. Clinical Trial.

• Strategies to Increase Cervical Cancer Screening With Mailed Human Papillomavirus Self-Sampling Kits: A Randomized Clinical Trial.

  Winer RL, Lin J, Anderson ML, Tiro JA, Green BB, Gao H, Meenan RT, Hansen K, Sparks A, Buist DSM. Winer RL, et al. JAMA. 2023 Nov 28;330(20):1971-1981. doi: 10.1001/jama.2023.21471. JAMA. 2023. PMID: 38015219 Free PMC article. Clinical Trial.

• Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review.

  Madzima TR, Vahabi M, Lofters A. Madzima TR, et al. Can Fam Physician. 2017 Aug;63(8):597-601. Can Fam Physician. 2017. PMID: 28807952 Free PMC article. Review.

• The advent of human papillomavirus detection for cervical screening.

  Morris BJ. Morris BJ. Curr Opin Obstet Gynecol. 2019 Oct;31(5):333-339. doi: 10.1097/GCO.0000000000000542. Curr Opin Obstet Gynecol. 2019. PMID: 30946033 Review.

• Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening.

  Meenan RT, Troja C, Buist DSM, Tiro JA, Lin J, Anderson ML, Gao H, Green BB, Winer RL. Meenan RT, et al. JAMA Netw Open. 2023 Mar 1;6(3):e234052. doi: 10.1001/jamanetworkopen.2023.4052. JAMA Netw Open. 2023. PMID: 36947040 Free PMC article. Clinical Trial.

• Beliefs and Perceptions in Attending the Cervical Screening: The COMUNISS Project Experience.

  Muresu N, Sechi I, Puci MV, Dettori M, Piana A. Muresu N, et al. Cancers (Basel). 2025 Jan 9;17(2):190. doi: 10.3390/cancers17020190. Cancers (Basel). 2025. PMID: 39857972 Free PMC article.

• Design of a pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake in a U.S. healthcare system: The STEP trial.

  Winer RL, Lin J, Anderson ML, Tiro JA, Meenan RT, Hansen K, Gao H, Sparks A, Greene DN, Kilgore-Martin S, Green BB, Buist DSM. Winer RL, et al. Contemp Clin Trials. 2022 Nov;122:106960. doi: 10.1016/j.cct.2022.106960. Epub 2022 Oct 12. Contemp Clin Trials. 2022. PMID: 36241145 Free PMC article. Clinical Trial.

• Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study.

  Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. Xiong S, et al. Implement Sci Commun. 2022 Dec 13;3(1):130. doi: 10.1186/s43058-022-00382-3. Implement Sci Commun. 2022. PMID: 36514133 Free PMC article.

• COVID-19 as a catalyst for reimagining cervical cancer prevention.

  Luckett R, Feldman S, Woo YL, Moscicki AB, Giuliano AR, de Sanjosé S, Kaufmann AM, Leung SOA, Garcia F, Chan K, Bhatla N, Stanley M, Brotherton J, Palefsky J, Garland S; International Papillomavirus Society (IPVS) Policy Committee. Luckett R, et al. Elife. 2023 Apr 18;12:e86266. doi: 10.7554/eLife.86266. Elife. 2023. PMID: 37070731 Free PMC article.

1. 1. Sabatino SA, White MC, Thompson TD, Klabunde CN; Centers for Disease Control and Prevention (CDC) . Cancer screening test use—United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64(17):-. - PMC - PubMed
2. 1. National Committee for Quality Assurance Cervical cancer screening (CCS). https://www.ncqa.org/hedis/measures/cervical-cancer-screening/. Published 2018. Accessed April 1, 2019.
3. 1. White A, Thompson TD, White MC, et al. . Cancer screening test use—United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(8):201-206. doi:10.15585/mmwr.mm6608a1 - DOI - PMC - PubMed
4. 1. Oscarsson MG, Benzein EG, Wijma BE. Reasons for non-attendance at cervical screening as reported by non-attendees in Sweden. J Psychosom Obstet Gynaecol. 2008;29(1):23-31. doi:10.1080/01674820701504619 - DOI - PubMed
5. 1. Glasgow RE, Whitlock EP, Valanis BG, Vogt TM. Barriers to mammography and Pap smear screening among women who recently had neither, one or both types of screening. Ann Behav Med. 2000;22(3):223-228. doi:10.1007/BF02895117 - DOI - PubMed

RetroSearch is an open source project built by @garambo | Open a GitHub Issue

Search and Browse the WWW like it's 1997 | Search results from DuckDuckGo

HTML: 3.2 | Encoding: UTF-8 | Version: 0.7.3