INTRODUCTION

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 Self-sampled 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.

METHODS

Study Population

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.

Measures

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.

Statistical Analysis

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.

RESULTS

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 1 Awareness of HPV Testing Option and Patient-Reported Cervical Cancer Screening History by Sociodemographic Factors
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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.

Table 2 Acceptability of Self-sampling for HPV Testing by Sociodemographic Factors
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DISCUSSION

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 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 self-sampling 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.