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Perceptions of Mailed HPV Self-testing Among Women at Higher Risk for Cervical Cancer

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Abstract

Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer prevention. We conducted a telephone survey of 199 women in North Carolina. Eligibility criteria included not having had a Pap test in 4 years and reporting 1 or more indicators of economic hardship, such as being uninsured. Over half (55 %) of women in the diverse sample were non-Hispanic black, and almost three-quarters (74 %) reported annual household incomes of $20,000 or less. Trust in HPV self-testing was moderate to high, with almost all women (98 %) agreeing the mailed test was safe. A few women (6 %) preferred HPV self-testing to Pap testing for protecting health, but most (75 %) had no preference. Trust in or preference for mailed self-testing did not vary by race or income. However, compared to white women, black women had lower HPV-related knowledge (OR 0.46, 95 % CI 0.23–0.92) and perceived lower cervical cancer risk in the absence of screening (OR 0.44, 95 % CI 0.22–0.86). We found similar patterns of disparities for women with very low (<$10,000) versus relatively higher incomes. Our findings suggest that, across racial and economic subgroups, under-screened women generally trust HPV self-tests delivered by mail. To succeed, programs for HPV self-testing must overcome disparities in knowledge and perceptions related to cervical cancer screening.

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References

  1. American Cancer Society. (2014). Cervical cancer. Retrieved from: http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics.

  2. Singh, G. K., Miller, B. A., Hankey, B. F., & Edwards, B. K. (2004). Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975–2000. Cancer, 101, 1051–1057.

    Article  PubMed  Google Scholar 

  3. Freeman, H. P., & Wingrove, B. K. (2005). Excess cervical cancer mortality: A marker for low access to health care in poor communities. Rockville, MD: National Cancer Institute, Center to Reduce Cancer Health Disparities (NIH Pub. No. 05-5282).

  4. Albano, J. D., Ward, E., Jemal, A., Anderson, R., Cokkinides, V. E., Murray, T., et al. (2007). Cancer mortality in the United States by education level and race. Journal of the National Cancer Institute, 99, 1384–1394.

    Article  PubMed  Google Scholar 

  5. Simard, E. P., Ward, E. M., Siegel, R., & Jemal, A. (2012). Cancers with increasing incidence trends in the United States: 1999 through 2008. CA: A Cancer Journal for Clinicians, 62, 118–128.

    Article  Google Scholar 

  6. National Cancer Institute. (2014). SEER stat fact sheet: Cervix uteri. Retrieved from: http://seer.cancer.gov/statfacts/html/cervix.html.

  7. Petignat, P., Faltin, D. L., Bruchim, I., Tramèr, M. R., Franco, E. L., & Coutlée, F. (2007). Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis. Gynecologic Oncology, 105, 530–535.

    Article  PubMed  Google Scholar 

  8. Lazcano-Ponce, E., Lorincz, A. T., Cruz-Valdez, A., Salmerón, J., Uribe, P., Velasco-Mondragón, E., et al. (2011). Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): A community randomized controlled trial. Lancet, 378, 1868–1873.

    Article  PubMed  Google Scholar 

  9. Balasubramanian, A., Kulasingam, S. L., Baer, A., Hughes, J. P., Myers, E. R., Mao, C., et al. (2010). Accuracy and cost-effectiveness of cervical cancer screening by high-risk HPV DNA testing of self-collected vaginal samples. Journal of Lower Genital Tract Disease, 14, 185–195.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Litton, A. G., Castle, P. E., Partridge, E. E., & Scarinci, I. C. (2013). Cervical cancer screening preferences among African American women in the Mississippi Delta. Journal of Health Care for the Poor and Underserved, 24, 46–55.

    Article  PubMed  Google Scholar 

  11. Anhang, R., Nelson, J. A., Telerant, R., Chiasson, M. A., & Wright, T. C, Jr. (2005). Acceptability of self-collection of specimens for HPV DNA testing in an urban population. Journal of Women’s Health, 14, 721–728.

    Article  PubMed  CAS  Google Scholar 

  12. Scarinci, I. C., Litton, A. G., Garces-Palacio, I. C., Partridge, E. E., & Castle, P. E. (2013). Acceptability and usability of self-collected sampling for HPV testing among African-American women living in the Mississippi Delta. Women’s Health Issues, 23, e123–e130.

    Article  PubMed  PubMed Central  Google Scholar 

  13. North Carolina Department of Commerce. County tier designations. Retrieved from: https://www.nccommerce.com/research-publications/incentive-reports/2011-county-tier-designations.

  14. US Census. Geographic comparability file, 2010 to 2000 county subdivisions. Retrieved from: http://www.census.gov/geo/maps-data/data/comp-sub.html.

  15. De Alba, I., Anton-Culver, H., Hubbell, F. A., Ziogas, A., Hess, J. R., Bracho, A., et al. (2008). Self-sampling for human papillomavirus in a community setting: Feasibility in Hispanic women. Cancer Epidemiology, Biomarkers and Prevention, 17, 2163–2168.

    Article  PubMed  Google Scholar 

  16. Cates, J. R., Brewer, N. T., Fazekas, K. I., Mitchell, C. E., & Smith, J. S. (2009). Racial differences in HPV knowledge, HPV vaccine acceptability, and related beliefs among rural, southern women. Journal of Rural Health, 25, 93–97.

    Article  PubMed  Google Scholar 

  17. American Cancer Society. Cervical cancer: Prevention and early detection. Retrieved from: http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervical-cancer-prevention-and-early-detection-toc.

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Acknowledgments

We would like to thank Andrea Des Marais, Rachel Larsen, Kristen Ricchetti-Masterson, Kelly Murphy, Belinda Yen-Lieberman, and Jerome Belinson for supporting this study. This research was supported by Kate B. Reynolds Charitable Trust. Additional support for staff time came from the Cancer Control Education Program at UNC Lineberger Comprehensive Cancer Center (R25 CA57726), the NCCU-LUCC Partnership in Cancer Research (5 U54 CA156733), and an unrestricted gift from GlaxoSmithKline.

Conflict of interest

J.S. has received grants from or served on paid advisory boards for Hologic-Genprobe, QIAGEN, and BD Corporation. NB has received grants from or served on paid advisory boards for GlaxoSmithKline and Merck Sharp & Dohme Corp. A.R. has received grants from Merck Sharp & Dohme Corp. K.G., M.G., and L.B. have no conflicts to report.

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Authors and Affiliations

  1. School of Nursing, University of North Carolina, Chapel Hill, NC, USA

    Kayoll V. Galbraith

  2. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Melissa B. Gilkey, Jennifer S. Smith & Noel T. Brewer

  3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2103 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA

    Jennifer S. Smith

  4. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, CB 7440, Chapel Hill, NC, 27599, USA

    Noel T. Brewer

  5. College of Health and Human Performance, East Carolina University, Greenville, NC, USA

    Alice R. Richman

  6. American Sexual Health Association, Research Triangle Park, NC, USA

    Lynn Barclay

Authors
  1. Kayoll V. Galbraith
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  2. Melissa B. Gilkey
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  3. Jennifer S. Smith
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  4. Alice R. Richman
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  5. Lynn Barclay
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  6. Noel T. Brewer
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Correspondence to Noel T. Brewer.

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Galbraith, K.V., Gilkey, M.B., Smith, J.S. et al. Perceptions of Mailed HPV Self-testing Among Women at Higher Risk for Cervical Cancer. J Community Health 39, 849–856 (2014). https://doi.org/10.1007/s10900-014-9931-x

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  • DOI: https://doi.org/10.1007/s10900-014-9931-x

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