A randomised trial of interventions to increase uptake of cervical screening among 25 year old non-attenders; final results of the STRATEGIC Trial.

Henry Kitchener1,Matthew Gittins2,Carly Moseley1,Margaret Cruickshank3,Samantha Fletcher1,Jamie Oughton1,Rebecca Albrow1,Emma Crosbie1,Chris Roberts2

1Institute of Cancer Sciences, University of Manchester, Manchester, UK,2Institute of Population Health, University of Mancchester, Manchester, UK,3Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, UK

Presenting date: Tuesday 3 November

Background

Cervical screening coverage amongst women has been falling in the UK and internationally, risking not only a rising incidence of cervical cancer in non-vaccinated women but also reduced engagement with cervical screening in later years.

Method

Following a pilot study, which demonstrated that self-sampling (SS) for HPV testing, timed appointments (TA), and choice between a nurse navigator (NN) or SS offered were all feasible and associated with increased uptake amongst non-attenders (6 months following their first invitation), a cluster randomised trial evaluated the effectiveness of these interventions in Greater Manchester and in Aberdeen, where HPV vaccinated teenagers have become eligible for cervical screening. General practices were randomised to one of five interventions; a) a SS sent unsolicited b) SS on request, c) NN, d) choice between the latter two or e) TA. A control group of practices had no interventions. Interventions were offered by a personalised letter from the NHS Screening Agency. The primary outcome was uplift in cervical screening 12 months following the intervention.

Results

272 general practices were randomised. SS kits were sent to 1139 women and offered to 1308. 1027 were offered a NN, 1282 a choice between NN and SS. TA’s were offered to 1560, 4066 acted as a control group. The uplift for each intervention was: SS sent, 20.8%; SS offered, 19.3%; NN 17.0%; and choice, 23.6% . None of these demonstrated a significant increase in uptake compared with controls (21.3%), with odds ratios of 0.98, 0.99, 0.80, 0.95, 1.1 respectively. In the Aberdeen cohort, incompletely and completely vaccinated women had a significantly increased uptake compared with unvaccinated; OR’s 2.19 (p= 0.036) and 2.5 (p= 0.001) respectively.

Conclusion

This large controlled study has not shown any benefit of interventions designed to increase uptake of cervical screening in young women receiving their initial invitation. Vaccinated women showed significantly greater uptake.