key: cord-0017388-s4ra3fyb
authors: Zhu, Xuan; MacLaughlin, Kathy L.; Fan, Chun; Jacobson, Debra J.; Jenkins, Gregory D.; Jacobson, Robert M.; Finney Rutten, Lila J.
title: Awareness of HPV Testing and Acceptability of Self-sampling for Cervical Cancer Screening Among Women in Minnesota
date: 2021-05-13
journal: J Gen Intern Med
DOI: 10.1007/s11606-021-06854-x
sha: 55936b67260152b8370c55dba691e629fe45232e
doc_id: 17388
cord_uid: s4ra3fyb

nan

Recent US data reveal concerning declines in cervical cancer (CC) screening rates and persistent disparities in CC screening and related outcomes by sociodemographic factors. 1, 2 The U.S. Preventive Services Task Force endorsement of HPV testing as a primary approach to CC screening offers an opportunity to explore self-sampling (patient collection of a vaginal swab) as an alternative to clinician sampling. 3 Selfsampled HPV testing with timely follow-up care has the potential to improve CC screening uptake particularly in low resource settings. With the goal to inform self-sampling interventions to improve HPV testing uptake among underscreened women, this study examines awareness and use of HPV testing and acceptability of self-sampling and differences by sociodemographic factors among CC screening-eligible women living in Minnesota.

Data were from the omnibus 2019 Minnesota State Survey implemented by the Minnesota Center for Survey Research at the University of Minnesota (UMN) through telephone interviews between October 2019 and March 2020, using a simple random sample of Minnesota adult residents with a landline or cell phone (N=612; response rate=10%). Telephone interviewing was abruptly terminated on March 16, 2020, when UMN suspended all on-campus work due to COVID-19. This study was approved by the UMN Institutional Review Board.

CC screening-eligible respondents (females ages 21-65 without hysterectomy; N=155) self-reported whether they had heard of HPV testing for CC screening and whether they have had a HPV or Pap test. Respondents were also asked to compare self-sampling for HPV testing to Pap testing done by a clinician in terms of convenience, embarrassment, ease, and pain, and likelihood of following up abnormal results with further testing. Sociodemographic factors including race/ethnicity, education, marital status, household income, housing, and metropolitan area were measured.

We report descriptive statistics for awareness of HPV testing as a screening option and CC screening history, and acceptance of self-sampling for HPV testing. We examined sociodemographic differences using chi-square test or Fisher's exact test. Table 1 summarizes sample characteristics and HPV testing awareness and self-reported HPV and Pap testing history by sociodemographic factors. Among screening-eligible respondents, 64.5% reported they have heard of HPV testing and 34.7% reported they have had HPV testing, while 89.5% reported they have had Pap testing. Women ages 21-29 (versus 30-65) less frequently heard of HPV testing (p=.041) while women ages 21-29 or 40-59 less frequently had HPV testing (p=.002). Women without a college degree (versus college graduates) less frequently heard of or had HPV testing (p=.014, .015). Additionally, women ages 21-29, racial/ethnic minority (versus non-Hispanic white) women, and women who rent (versus own) their homes less frequently had Pap testing (p=.044, .007, .015).

Table 2 summarizes acceptability of HPV testing self-sampling by sociodemographic factors. The majority of respondents reported self-sampling as more convenient (77.8%), less embarrassing (68.6%), easier (74.5%), and less painful (62.7%) compared to Pap testing done by a clinician. Women without a college degree more frequently rated self-sampling as less painful (p<.001), while women living in the largely rural greater Minnesota region (versus Twin Cities metropolitan area) more frequently rated self-sampling as more convenient and easier (p=.041, .002). Lastly, 94.8% of respondents reported that they would be likely to follow up with further testing upon receiving an abnormal result from the self-sampled HPV test.

Self-sampling for HPV testing was perceived as more convenient, less embarrassing, easier, and less painful than clinician sampling for Pap testing by most screening-eligible women we surveyed, especially women without a college degree and 

National assessment of HPV and Pap tests: Changes in cervical cancer screening, National Health Interview Survey

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement

Patterns and Trends in Cancer Screening in the United States

Persistent Disparities in Cervical Cancer Screening Uptake: Knowledge and Sociodemographic Determinants of Papanicolaou and Human Papillomavirus Testing Among Women in the United States

women living in the greater Minnesota region. Additionally, over 90% of women reported they would seek follow-up testing of an abnormal result from a self-sampled HPV test. These findings suggest that self-sampling has the potential to improve HPV testing uptake for women in medically underserved and rural communities. The disparities by age, education, race/ethnicity, and housing in HPV testing awareness and reported CC screening history confirm previous findings, 4, 5 suggesting interventions promoting HPV testing and selfsampling should focus on underserved populations to reduce existing CC disparities. These data can inform interventions to improve HPV testing uptake among underscreened women through self-sampling.Limitations of this research include the low response rate, which may introduce bias and limit the generalizability, and the small sample size, which limited statistical power for exploring interaction effects. 

Conflict of Interest: R.M.J. serves as a member of a safety review committee for post-licensure studies of human papillomavirus vaccines conducted by Merck and Co. and as a member of a data monitoring committee for a set of prelicensure trials of a 15-valent pneumococcal conjugate vaccine also conducted by Merck and Co.Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons. org/licenses/by/4.0/.