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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Letters to the Editor

When Is It Effective to Offer Self-Sampling to Non-Attendees—Response

Kirsten Rozemeijer, Inge M.C.M. de Kok, Steffie K. Naber, Folkert J. van Kemenade, Corine Penning, Joost van Rosmalen and Marjolein van Ballegooijen
Kirsten Rozemeijer
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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  • For correspondence: k.rozemeijer@erasmusmc.nl
Inge M.C.M. de Kok
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Steffie K. Naber
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Folkert J. van Kemenade
2Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Corine Penning
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Joost van Rosmalen
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
3Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Marjolein van Ballegooijen
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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DOI: 10.1158/1055-9965.EPI-15-0523 Published August 2015
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We appreciate Dr. Castle's concern that a loss in CIN2+ sensitivity, when using self-sampling instead of office-based sampling, may still be an issue (1), even though data of a recently published meta-analysis reported otherwise (2).

Data of the Dutch PROHTECT study strongly suggested that the CIN2+ sensitivity of HPV self-sampling was non-inferior to that of HPV office-based sampling (3). As self-sampling was offered to non-attendees at home, it is unlikely that the sensitivity profile in this study was biased because of “in office procedures,” although the PROHTECT study estimates may have been biased due to higher risk profiles in the non-attendees. Therefore, studies are needed to validate self-sampling test characteristics in regular responders with lower risk profiles in case they switch from office-based sampling to self-sampling.

In our article, we showed that even if the loss in CIN2+ sensitivity is 10%, and 20% to 30% of the regular attendees switch to self-sampling, it is still both effective and cost-effective to offer self-sampling to non-attendees as long as unscreened women attend, and the extra attendance rate is at least 6 percentage points (4). Results of the Dutch PROHTECT studies, where self-sampling was offered via an opt-out procedure (i.e., a self-sampling kit was sent to all non-attendees except when they opted-out via a letter), showed that both assumptions were realistic (3, 5). However, as opt-in procedures (i.e., involving a request for a self-sampler) may reduce response rates (6), the chosen strategy could be crucial in whether or not offering self-sampling is (cost-)effective. Therefore, we fully concur with Dr. Arbyn and Dr. Castle that the introduction of self-sampling strategies should be carefully prepared and evaluated in pilot studies integrated in well-organized settings before general rollout (6).

See the original Letter to the Editor, p. 1295

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

  • Received May 11, 2015.
  • Accepted May 14, 2015.
  • ©2015 American Association for Cancer Research.

References

  1. 1.↵
    1. Castle PE
    . When is it effective to offer self-sampling to non-attendees—letter. Cancer Epidemiol Biomarkers Prev 2015;24:1295.
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  2. 2.↵
    1. Arbyn M,
    2. Verdoodt F,
    3. Snijders PJF,
    4. Verhoef VM,
    5. Suonio E,
    6. Dillner L,
    7. et al.
    Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis. Lancet Oncol 2014;15:172–83.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Gök M,
    2. Heideman DA,
    3. van Kemenade FJ,
    4. Berkhof J,
    5. Rozendaal L,
    6. Spruyt JW,
    7. et al.
    HPV testing on self-collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: cohort study. BMJ 2010;340:c1040.
    OpenUrlAbstract/FREE Full Text
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    1. Rozemeijer K,
    2. de Kok IMCM,
    3. Naber SK,
    4. van Kemenade FJ,
    5. Penning C,
    6. van Rosmalen J,
    7. et al.
    Offering self-sampling to non-attendees of organized primary HPV screening: when do harms outweigh the benefits? Cancer Epidemiol Biomarkers Prev 2015;24:773–82.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Gök M,
    2. Heideman DA,
    3. van Kemenade FJ,
    4. de Vries AL,
    5. Berkhof J,
    6. Rozendaal L,
    7. et al.
    Offering self-sampling for human papillomavirus testing to non-attendees of the cervical screening programme: characteristics of the responders. Eur J Cancer 2012;48:1799–808.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Arbyn M,
    2. Castle PE
    . Offering self-sampling kits for HPV testing to reach women who do not attend in the regular cervical cancer screening program. Cancer Epidemiol Biomarkers Prev 2015;24:769–72.
    OpenUrlAbstract/FREE Full Text
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Cancer Epidemiology Biomarkers & Prevention: 24 (8)
August 2015
Volume 24, Issue 8
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When Is It Effective to Offer Self-Sampling to Non-Attendees—Response
Kirsten Rozemeijer, Inge M.C.M. de Kok, Steffie K. Naber, Folkert J. van Kemenade, Corine Penning, Joost van Rosmalen and Marjolein van Ballegooijen
Cancer Epidemiol Biomarkers Prev August 1 2015 (24) (8) 1296; DOI: 10.1158/1055-9965.EPI-15-0523

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When Is It Effective to Offer Self-Sampling to Non-Attendees—Response
Kirsten Rozemeijer, Inge M.C.M. de Kok, Steffie K. Naber, Folkert J. van Kemenade, Corine Penning, Joost van Rosmalen and Marjolein van Ballegooijen
Cancer Epidemiol Biomarkers Prev August 1 2015 (24) (8) 1296; DOI: 10.1158/1055-9965.EPI-15-0523
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