ArticleThe Lancet regional health. Europe2026
Effect of direct mailing self-sampling kits on participation in the Dutch hrHPV-based cervical screening programme: a population-based study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
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3 authors.
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Abstract
Background: In July 2023, the Dutch cervical cancer screening programme introduced direct mailing of self-sampling kits with invitations for 30-year-olds and with reminder for non-participants in other age groups after 12 weeks. This study evaluates the impact of this new policy on participation, self-sampling uptake, and follow-up testing. Methods: Data from the national screening (ScreenIT) and pathology (Palga) databases were used. Individuals invited between July 11 and December 31, 2023, were compared to a control group from the same period in 2022. Primary outcomes included participation rates following invitation and reminder, time to participation, self-sampling uptake, reflex cytology participation among high-risk HPV(hrHPV)-positive self-sampling participants, and first-time participation. Analyses were stratified by age and screening history. Findings: Overall participation increased from 42.1% (n = 330,413) in the control group to 49.9% (n = 327,376; RR: 1.19, 95% CI: 1.18-1.19) with the new policy. After primary invitation, the largest increase in participation from 30.6% to 40.3% was observed among 30-year-olds (RR: 1.32, 95% CI: 1.30-1.34). Vaginal self-sampling uptake increased from 21.9% to 61.9% (RR: 2.82, 95% CI: 2.79-2.85), with the largest uptake among first-time participants (previous non-attenders, 32.1%-78.1%; RR: 2.43, 95% CI: 2.35-2.51) and 30-34-year-olds (25.1%-83.7%; RR: 3.33, 95% CI: 2.25-3.40). The proportion of first-time participants increased from 6.8% in the control group to 9.1% with the new policy. Participation increased sharply in individuals aged 35+ after 12 weeks. Reflex cytology participation among hrHPV-positive self-sampling participants declined by 6% (from 93% to 87%; RR: 0.94, 95% CI: 0.93-0.95), but this did not affect the overall increase in participation rates. Interpretation: Direct mailing of self-sampling kits is an effective strategy to increase participation in population-based cervical cancer screening programmes, especially among first-time invitees and previous non-attenders. Continued participation in reflex cytology among hrHPV-positive women remains essential to maximise the overall impact of the policy on screening effectiveness. Funding: This study was funded by the National Institute for Public Health and the Environment.
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