TOPLINE

Home-based human papillomavirus (HPV) screening for cervical cancer shows modest uptake in a diverse community setting, with approximately 1 in 5 eligible patients requesting kits and about half returning samples. White patients, older individuals, and those with prior screening adherence are more likely to participate, while patients with unknown screening history or no recent BMI recording show lower engagement.

METHODOLOGY

• Researchers conducted a cohort study approved by the Kaiser Permanente Northern California institutional review board during a 9-week period, offering home cervical cancer screening to patients aged 25-62 years residing in two of the health system’s 21 geographic service areas in the US.
• A total of 13,714 patients (median age 43 years; 26.1% Asian or Pacific Islander, 6.2% Black, 20.9% Hispanic, 39.1% White, 7.8% mixed race or other) who were due or soon due for routine screening, or whose screening status was unknown, were offered home screening via email with links to additional education.
• Patients who opted in were sent a screening kit using a flocked swab for vaginal self-collection, with postage paid to a processing laboratory for HPV testing, and were required to return their sample within 60 days.
• Primary outcomes were opt-in rate (percentage of patients requesting a home collection kit) and sample return rate (percentage of patients sent a kit who returned a sample within 60 days), with associations assessed using adjusted prevalence ratios.
• Patient characteristics including age, race and ethnicity, screening history, BMI, distance to nearest medical center, Neighborhood Deprivation Index, and Charlson Comorbidity Index were assessed using electronic databases.

TAKEAWAY

• Among 13,714 patients offered home screening, 2557 (18.6%) requested kits, with higher opt-in rates associated with White race (49.4% of those opting in), older age (adjusted prevalence ratio [APR], 1.34 for ages 55-62 vs 40-44; 95% CI, 1.20-1.49; P < .001), and higher comorbidity (Charlson comorbidity index 1-2 vs 0: APR, 1.12; 95% CI, 1.03-1.22; P = .007).
• Patients with unknown screening history were less likely to opt in (APR, 0.69; 95% CI, 0.58-0.83; P = .001), as were those without a recorded BMI in the prior 3 years (APR, 0.46; 95% CI, 0.34-0.64; P = .001), and those traveling more than 5 miles to a medical center compared with those living closer.
• Among 2557 patients sent kits, 1382 (54.0%) returned a sample within 60 days (median 23 days), with sample return associated with age ≥ 45 years (APR, 1.18; 95% CI, 1.07-1.27; P = .001), White race, and history of screening adherence.
• Being overdue for screening (APR, 0.66; 95% CI, 0.44-0.98; P = .04), having unknown screening history (APR, 0.76; 95% CI, 0.60-0.95; P = .02), higher BMI (APR, 0.79; 95% CI, 0.72-0.86; P = .001), and higher comorbidity burden (APR, 0.77; 95% CI, 0.62-0.97; P = .03) were associated with lower sample return rates.

IN PRACTICE:

“Overall, the findings suggest that a substantial proportion of eligible patients will elect home-based screening, but efforts are needed to support participation across demographic groups,” wrote the authors of the study.

SOURCE

The study was led by Elizabeth J. Suh-Burgmann, MD, Division of Gynecologic Oncology, The Permanente Medical Group, Division of Research, Kaiser Permanente Northern California, Walnut Creek, California. It was published online on June 26 in JAMA Network Open.

LIMITATIONS

The study has several limitations that may affect the generalizability and interpretation of the findings. The initial phase involved only two of the health system’s 21 geographic service areas, limiting the geographic scope. Certain patient groups were excluded from the study, including those assessed by the system to be overdue for screening, patients aged 63-65 years, and pregnant individuals, which may have affected the representativeness of the sample. Additionally, patients with unknown screening history or no recorded BMI in the past 3 years had lower opt-in rates, possibly reflecting lower health system engagement, which could introduce selection bias. The study setting allows primary HPV screening to start at age 25, whereas some guidelines recommend starting at age 30, which may limit applicability to other settings with different screening protocols.

DISCLOSURES

The study received funding from the Kaiser Permanente Northern California Delivery Science Program. Julie A. Schmittdiel, PhD, disclosed receiving grants from the Permanente Medical Group during the conduct of the study. No other disclosures were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.