{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:55:23Z","timestamp":1788951323476,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T00:00:00Z","timestamp":1732320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2025,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Broad accessibility to cervical cancer screening and high participation rate is essential to reduce cervical cancer incidence. HPV self\u2010sampling is an alternative to clinician collected cervical samples to increase accessibility and screening coverage. To inform on deployment strategies of HPV self\u2010sampling, this large\u2010scale, randomized, pragmatic study compared two invitation modalities; direct\u2010mail and opt\u2010in. The study included screening non\u2010attenders from the Capital Region of Denmark randomly allocated (1:4) to a direct\u2010mail or opt\u2010in invitation for cervical screening by HPV self\u2010sampling. Primary endpoint was screening participation; secondary endpoints were HPV prevalence and histology outcome. Adherence to follow\u2010up and cost were also evaluated. After exclusion of hysterectomized\/non\u2010accessible women, 49,393 women were invited: 9639 by direct\u2010mail, and 39,754 by the opt\u2010in offer. A direct\u2010mail invitation for HPV self\u2010sampling yielded a significant higher participation than an opt\u2010in invitation. HPV self\u2010sample participation for direct\u2010mail was 25.2% (<jats:italic>n<\/jats:italic>\u2009=\u20092426), opt\u2010in participation was 20.2% (<jats:italic>n<\/jats:italic>\u2009=\u20098047), adjusted OR\u2009=\u20091.27, 95% CI 1.20\u20131.34. Participation increased with age (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001) for both strategies and decreased with screening history of non\u2010attendance (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Interaction between invitation strategy and age\/screening history was found; more women below 50\u2009years of age participated by direct\u2010mail compared to opt\u2010in (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001) and higher participation by direct\u2010mail group was found in women with a short history of non\u2010attendance (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). Participation of long\u2010term unscreened women was similar between arms. The relative cost was \u224814 HPV self\u2010sample kits distributed per additional participant by direct\u2010mail over opt\u2010in. HPV prevalence, adherence to follow\u2010up, and detection of high\u2010grade cervical intraepithelial neoplasia was similar between invitation strategies.<\/jats:p>","DOI":"10.1002\/ijc.35263","type":"journal-article","created":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T11:04:26Z","timestamp":1732359866000},"page":"1594-1605","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Participation and relative cost of attendance by direct\u2010mail compared to opt\u2010in invitation strategy for <scp>HPV<\/scp> self\u2010sampling targeting cervical screening non\u2010attenders: A large\u2010scale, randomized, pragmatic study"],"prefix":"10.1002","volume":"156","author":[{"given":"Birgitte T\u00f8nnes","family":"Pedersen","sequence":"first","affiliation":[{"name":"Department of Pathology Copenhagen University Hospital AHH\u2010Hvidovre  Hvidovre 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