Cited by 332Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

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Interventions targeted at women to encourage the uptake of cervical screening

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Everett, Thomas, Bryant, Andrew, Griffin, Michelle F, Martin-Hirsch, Pierre PL, Forbes, Carol A, Jepson, Ruth G·2011·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd002834.pub2PMC PMC4163962

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Abstract

BACKGROUND: This is an update of the Cochrane review published in Issue 5, 2011. Worldwide, cervical cancer is the fourth commonest cancer affecting women. High-risk human papillomavirus (HPV) infection is causative in 99.7% of cases. Other risk factors include smoking, multiple sexual partners, the presence of other sexually transmitted diseases and immunosuppression. Primary prevention strategies for cervical cancer focus on reducing HPV infection via vaccination and data suggest that this has the potential to prevent nearly 90% of cases in those vaccinated prior to HPV exposure. However, not all countries can afford vaccination programmes and, worryingly, uptake in many countries has been extremely poor. Secondary prevention, through screening programmes, will remain critical to reducing cervical cancer, especially in unvaccinated women or those vaccinated later in adolescence. This includes screening for the detection of pre-cancerous cells, as well as high-risk HPV. In the UK, since the introduction of the Cervical Screening Programme in 1988, the associated mortality rate from cervical cancer has fallen. However, worldwide, there is great variation between countries in both coverage and uptake of screening. In some countries, national screening programmes are available whereas in others, screening is provided on an opportunistic basis. Additionally, there are differences within countries in uptake dependent on ethnic origin, age, education and socioeconomic status. Thus, understanding and incorporating these factors in screening programmes can increase the uptake of screening. This, together with vaccination, can lead to cervical cancer becoming a rare disease. OBJECTIVES: To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical screening. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 6, 2020. MEDLINE, Embase and LILACS databases up to June 2020. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical screening. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. Where possible, the data were synthesised in a meta-analysis using standard Cochrane methodology. MAIN RESULTS: Comprehensive literature searches identified 2597 records; of these, 70 met our inclusion criteria, of which 69 trials (257,899 participants) were entered into a meta-analysis. The studies assessed the effectiveness of invitational and educational interventions, lay health worker involvement, counselling and risk factor assessment. Clinical and statistical heterogeneity between trials limited statistical pooling of data. Overall, there was moderate-certainty evidence to suggest that invitations appear to be an effective method of increasing uptake compared to control (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.49 to 1.96; 141,391 participants; 24 studies). Additional analyses, ranging from low to moderate-certainty evidence, suggested that invitations that were personalised, i.e. personal invitation, GP invitation letter or letter with a fixed appointment, appeared to be more successful. More specifically, there was very low-certainty evidence to support the use of GP invitation letters as compared to other authority sources' invitation letters within two RCTs, one RCT assessing 86 participants (RR 1.69 95% CI 0.75 to 3.82) and another, showing a modest benefit, included over 4000 participants (RR 1.13, 95 % CI 1.05 to 1.21). Low-certainty evidence favoured personalised invitations (telephone call, face-to-face or targeted letters) as compared to standard invitation letters (RR 1.32, 95 % CI 1.11 to 1.21; 27,663 participants; 5 studies). There was moderate-certainty evidence to support a letter with a fixed appointment to attend, as compared to a letter with an open invitation to make an appointment (RR 1.61, 95 % CI 1.48 to 1.75; 5742 participants; 5 studies). Low-certainty evidence supported the use of educational materials (RR 1.35, 95% CI 1.18 to 1.54; 63,415 participants; 13 studies) and lay health worker involvement (RR 2.30, 95% CI 1.44 to 3.65; 4330 participants; 11 studies). Other less widely reported interventions included counselling, risk factor assessment, access to a health promotion nurse, photo comic book, intensive recruitment and message framing. It was difficult to deduce any meaningful conclusions from these interventions due to sparse data and low-certainty evidence. However, having access to a health promotion nurse and attempts at intensive recruitment may have increased uptake. One trial reported an economic outcome and randomised 3124 participants within a national screening programme to either receive the standard scr

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Authors: Everett, T., Bryant, A., Griffin, M. F., Martin-Hirsch, P. P., Forbes, C. A., & Jepson, R. G.
Affiliations: Addenbrooke's Hospital (GB)
Newcastle University (GB)
Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust; Gynaecological Oncology Unit; Sharoe Green Lane Fullwood Preston Lancashire UK PR2 9HT
University of York (GB)
Scottish Collaboration for Public Health Research and Policy (GB)
ORCID: Everett, Thomas
Bryant, Andrew
Griffin, Michelle F
Forbes, Carol A
Jepson, Ruth G
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2011-05-11
Volume: 9
Issue: 5
Pages: CD002834-CD002834
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd002834.pub2
PMC: PMC4163962
OpenAlex: W1933814988
Cited by: 332
References: 214
Citations by year: 2026: 5 · 2025: 8 · 2024: 11 · 2023: 36 · 2022: 20 · 2021: 22 · 2020: 17 · 2019: 15 · 2018: 22 · 2017: 20 · 2016: 38 · 2015: 20 · 2014: 14 · 2013: 17 · 2012: 11
FWCI: 1.84
Type: journal article
Language: en
Update notices: new_version (2021-09-06)
Open access: hybrid
doi.org
Licence: other-oa
Locations: Cochrane Database of Systematic Reviews (publishedVersion, other-oa)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
Newcastle University ePrints (Newcastle Univesity)
Topics: Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords: cervical cancer screening, screening uptake, women, health education intervention, educational intervention, informed consent, cervical cancer prevention, HPV vaccination, screening programs, barriers to screening, cervical cancer mortality, socioeconomic status, ethnic differences, screening coverage, opportunistic screening
MeSH terms: Uterine Cervical Neoplasms, Female, Humans, Mass Screening, Patient Acceptance of Health Care, Precancerous Conditions, Vaginal Smears, Randomized Controlled Trials as Topic, Reminder Systems

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Interventions targeted at women to encourage the uptake of cervical screening

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