Assessing the impact of mailing self-sampling kits for human papillomavirus testing to unscreened non-responder women in Manitoba

Background

CervixCheck, Manitoba's cervical cancer screening program, conducted a pilot study to assess whether screening participation could be improved in unscreened women by offering a mailed self-sampling kit for human papillomavirus (hpv) testing instead of a Pap test.

Methods

In a prospective cohort study design, a sample of unscreened women (n = 1052) who had been sent an invitation letter from CervixCheck in the past but who did not respond were randomized to either an intervention group or a control group. The intervention group received a mailed hpv self-sampling kit; the control group received no additional communication. Returned hpv self-sampling swabs were analyzed by a provincial laboratory. After 6 months, screening participation in the two study groups was compared using a logistic regression model adjusted for age and area of residence (urban or rural). Secondary outcomes included hpv positivity, specimen inadequacy, compliance with follow-up, and time to colposcopy.

Results

Screening participation was significantly higher in the intervention group than in the control group (n = 51, 9.6%, vs. n = 13, 2.5%; odds ratio: 4.7; 95% confidence interval: 2.56 to 8.77). Geographic area of residence (urban or rural) and age were not statistically significant.

Conclusions

The study demonstrated that hpv self-sampling kits can enhance screening participation in unscreened non-responder women in the setting of an organized screening program. Next steps should include additional research to determine the best implementation strategy for hpv self-sampling in Manitoba.

Global Health Strategy for Cancer: Think Globally, Act Locally! Building a Collaborative Partnership Between Manitoba (Canada) and Jaffna (Sri Lanka)

Background and context: The number of people diagnosed with cancer worldwide is estimated to double by 2035. The greatest increase is expected in low- and middle-income countries (LMIC) due to demographic changes, such as ageing and growing populations, and increasing exposure to risk factors. Approximately 8.8 million people die each year of cancer, or one in 6 deaths globally. The Canadian government has recently renewed its commitment as a progressive global citizen with efforts including improvement of global health equity. CancerCare Manitoba is the provincial agency responsible for cancer and blood disorders, including the delivery of a wide range of clinical services from prevention to screening to treatment and supportive services, as well as cancer surveillance, research, and education. CancerCare Manitoba has identified potential partnerships with governments, nongovernmental organizations, academic institutions, and funders to address current and future challenges related to global cancer control. This includes several LMIC partners who have expressed an interest in working with Manitoba on cancer-related issues. In this presentation, we will describe our plans and early experience with a team from the University of Jaffna, the northern region of Sri Lanka. With a focus initially on surveillance and cancer control planning, there is an excellent opportunity for mutual learning and advancement of programs for cancer surveillance and planning. Aim: To establish a local partnership by connecting Manitoba, Canada with an engaged team from the University of Jaffna, Sri Lanka to advance cancer surveillance and planning, and contribute to the “global war on cancer”. Strategy/Tactics: A phased approach is being taken to address locally identified needs for cancer control. CancerCare Manitoba staff will be part of the mentorship team working with local partners in Jaffna to ensure development of local capacity. Specifically, we will: initiate cancer surveillance and establish a cancer registry in Jaffna (building from a cross-sectional study → hospital based registry → regional registry); analyze data and report on patterns; and establish a strategic plan for cancer control. Program/Policy process: Early planning is underway, involving collaborators from Manitoba and Jaffna. A project proposal has been developed to provide scope and acquire seed funding. Outcomes: Success will be determined based on the context of each program, including: establishing a framework for cancer surveillance; satisfaction of local and international partners (e.g., the Global Cancer Surveillance unit at the International Agency for Research in Cancer); and production of reports as a basis for cancer control. What was learned: Early learnings include the importance of local engagement and dedicated mentorship to advance global health equity, manage challenges around (sustained) funding, and establish a foundation of motivated partners.