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Research Article

Participation in cervical screening by self-collection, Pap, or a choice of either in Brazil

Philip E. Castle, Vânia R. S. Silva, Marcia E. L. Consolaro, Nádia Kienen, Lorna Bittencourt, Sandra M Pelloso, Edward E. Partridge, Amanda Pierz, Camila Buziquia Dartibale, Nelson S Uchimura and Isabel C. Scarinci
Philip E. Castle
Department of Epidemiology and Population Health, Albert Einstein College of Medicine
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  • For correspondence: castle.philip@gmail.com
Vânia R. S. Silva
Análises Clínicas e Biomedicina, Universidade Estadual de Maringá
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Marcia E. L. Consolaro
Clinical Analysis and Biomedicine, State University of Maringá
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Nádia Kienen
Psicologia Geral e Análise do Comportamento, Universidade Estadual de Londrina
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Lorna Bittencourt
University of Alabama at Birmingham
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Sandra M Pelloso
Nursing, State University of Maringá
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Edward E. Partridge
Comprehensive Cancer Cetner, University of Alabama at Birmingham
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Amanda Pierz
Albert Einstein College of Medicine
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Camila Buziquia Dartibale
Departamento de Medicina, Universidade Estadual de Maringá
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Nelson S Uchimura
Universidade Estadual de Maringá
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Isabel C. Scarinci
Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham
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DOI: 10.1158/1940-6207.CAPR-18-0419
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Abstract

Most cervical cancers occur in women who do not participate in cervical-cancer screening. We therefore evaluated adherence to screening for clinic-based Pap testing, self-collected sampling for HPV testing, and choice of the two among 483 un/under-screened women in Brazil. Three public Basic Health Units (BHUs) were each randomly assigned to three arms: (1) Pap testing at the BHU (N=160), (2) "Self&HPV" (self-collection for HPV testing) (N=161), and (3) "Choice" between self-collection and HPV testing and Pap test at the local BHU (N=162). The theory-based (PEN-3 and Health Belief Model) intervention in all three arms was implemented by trained Community Health Workers (CHWs) at participants' home. With the first invitation, 60.0% in the Pap Arm, 95.1% (154 of 161 [95.7%] who selected Self&HPV and 0 of 1 [0.0%] who selected Pap) in the Choice Arm, and 100% in the Self&HPV Arm completed screening. By the second invitation to choose a method of screening in the Choice Arm, 100% completed screening. After three invitations, 75.0% of women in the Pap Arm completed screening. Adherence to screening differed by study arm (p<0.001). In conclusion, Self&HPV testing is a promising strategy for un/under-screened women who are recalcitrant or unable to undergo clinic-based cervical screening to complement the screening modality used in the general population. In Brazil, where Pap testing is recommended for routine cervical screening, training CHWs in behavior change strategies and offering Self&HPV or Choice could greatly improve screening population coverage by reaching the un/under-screened populations.

  • Received October 30, 2018.
  • Revision received January 10, 2019.
  • Accepted January 11, 2019.
  • Copyright ©2019, American Association for Cancer Research.

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Published OnlineFirst January 16, 2019
doi: 10.1158/1940-6207.CAPR-18-0419

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Participation in cervical screening by self-collection, Pap, or a choice of either in Brazil
Philip E. Castle, Vânia R. S. Silva, Marcia E. L. Consolaro, Nádia Kienen, Lorna Bittencourt, Sandra M Pelloso, Edward E. Partridge, Amanda Pierz, Camila Buziquia Dartibale, Nelson S Uchimura and Isabel C. Scarinci
Cancer Prev Res January 16 2019 DOI: 10.1158/1940-6207.CAPR-18-0419

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Participation in cervical screening by self-collection, Pap, or a choice of either in Brazil
Philip E. Castle, Vânia R. S. Silva, Marcia E. L. Consolaro, Nádia Kienen, Lorna Bittencourt, Sandra M Pelloso, Edward E. Partridge, Amanda Pierz, Camila Buziquia Dartibale, Nelson S Uchimura and Isabel C. Scarinci
Cancer Prev Res January 16 2019 DOI: 10.1158/1940-6207.CAPR-18-0419
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eISSN: 1940-6215
ISSN: 1940-6207

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