Bo T. Hansen

Sociodemographic characteristics associated with cervical cancer screening participation by send‐to‐all and opt‐in HPV self‐sampling: Who benefits? Results from a randomized controlled trial among long‐term non‐attending women in Norway

AbstractWith the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under‐screened women, we randomized a random sample of 6000 women in Norway aged 35–69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self‐sampling kit (opt‐in), or (iii) a self‐sampling kit unsolicited (send‐to‐all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send‐to‐all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt‐in arm, we observed smaller, and at times, non‐significant increases within the range 0.7% (95% CI = −5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send‐to‐all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt‐in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (−12.7%, 95% CI = −19.7% to −5.7%). Self‐sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self‐sampling, especially with the goal to reach long‐term non‐attending women.

Regional differences in cervical cancer incidence and associated risk behaviors among Norwegian women: a population-based study

Abstract Background Cervical cancer incidence is influenced by screening and risk factors in the population. The main risk factor for cervical cancer is sexually transmitted human papillomavirus (HPV), which is sexually transmitted and thus associated with sexual behavior. Smoking, parity and hormonal contraceptive use may also be associated with cervical cancer risk. We compared incidence, screening coverage and risk behaviors for cervical cancer between health regions in Norway. Methods We obtained data on incidence of cervical cancer among Norwegian women during 1992–2016 and data on screening coverage from the Cancer Registry of Norway. We obtained data on sexual behavior and smoking from a population-based survey of 16,575 Norwegian women who were 18–45 years old in 2005. Results Cervical cancer incidence was higher in the northern and southeastern region than in the middle and western region (range in incidence per 100,000 person-years during 1992–2016; north: 10.5 to 14.6; southeast: 9.3 to 12.9; mid: 6.8 to 9.5; west: 8.4 to 10.0). The incidence decreased modestly in the north (average annual percentage change (95% confidence interval) − 1.0 (− 1.2 to − 0.7)) and southeast (− 0.7 (− 1.0 to − 0.3)), but did not change significantly in the mid (− 0.3 (− 1.0 to 0.4)) and west (− 0.3 (− 0.6 to 0.0)). Compared to the national average, women in the north had earlier sexual debut, more partners and higher prevalence of ever having had a sexually transmitted infection (STI), while the opposite was observed among women in the west. Women in the middle and southeastern regions tended to be similar to the national average for sexual behaviors. Although less pronounced, the prevalence of smoking showed regional patterns similar to that observed for sexual behaviors, while ever-use of hormonal contraceptives and cervical screening coverage was similar between regions. Conclusions There were regional differences in cervical cancer incidence during the era of nationally organized cervical screening in Norway. To some extent, these differences corresponded to regional differences in risk behavior for cervical cancer in the Norwegian female population.

Switching clinic‐based cervical cancer screening programs to human papillomavirus self‐sampling: A cost‐effectiveness analysis of vaccinated and unvaccinated Norwegian women

AbstractSeveral countries have implemented primary human papillomavirus (HPV) testing for cervical cancer screening. HPV testing enables home‐based, self‐collected sampling (self‐sampling), which provides similar diagnostic accuracy as clinician‐collected samples. We evaluated the impact and cost‐effectiveness of switching an entire organized screening program to primary HPV self‐sampling among cohorts of HPV vaccinated and unvaccinated Norwegian women. We conducted a model‐based analysis to project long‐term health and economic outcomes for birth cohorts with different HPV vaccine exposure, that is, preadolescent vaccination (2000‐ and 2008‐cohorts), multiage cohort vaccination (1991‐cohort) or no vaccination (1985‐cohort). We compared the cost‐effectiveness of switching current guidelines with clinician‐collected HPV testing to HPV self‐sampling for these cohorts and considered an additional 44 strategies involving either HPV self‐sampling or clinician‐collected HPV testing at different screening frequencies for the 2000‐ and 2008‐cohorts. Given Norwegian benchmarks for cost‐effectiveness, we considered a strategy with an additional cost per quality‐adjusted life‐year below $55 000 as cost‐effective. HPV self‐sampling strategies considerably reduced screening costs (ie, by 24%‐40% across cohorts and alternative strategies) and were more cost‐effective than clinician‐collected HPV testing. For cohorts offered preadolescent vaccination, cost‐effective strategies involved HPV self‐sampling three times (2000‐cohort) and twice (2008‐cohort) per lifetime. In conclusion, we found that switching from clinician‐collected to self‐collected HPV testing in cervical screening may be cost‐effective among both highly vaccinated and unvaccinated cohorts of Norwegian women.