{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T07:00:51Z","timestamp":1792998051740,"version":"4.5.0"},"reference-count":46,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CIHR # MOP - 119344"],"award-info":[{"award-number":["CIHR # MOP - 119344"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,9,6]]},"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The incidence of cervical cancer is up to 20-fold higher among First Nations women in Canada than the general population, probably due to lower participation in screening. Offering human papillomavirus (HPV) self-sampling in place of Papanicolaou (Pap) testing may eventually increase screening participation and reduce cervical cancer rates in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A community-randomised controlled screening trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>First Nations communities in Northwest Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women aged between 25 and 69, living in Robinson Superior Treaty First Nations. The community was the unit of randomisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Women were asked to complete a questionnaire and have screening by HPV self-sampling (arm A) or Pap testing (arm B).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>The number of women who participated in cervical screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Randomisation<\/jats:title>\n                    <jats:p>Community clusters were randomised to include approximately equivalent numbers of women in each arm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>6 communities were randomised to arm A and 5 to arm B. One community withdrew, leaving 5 communities in each group (834 eligible women). Participation was &lt;25%. Using clustered intention-to-treat (ITT) analysis, initial and cumulative averaged uptakes in arm A were 1.4-fold (20% vs 14.3%, p=0.628) and 1.3-fold (20.6% vs 16%, p=0.694) higher compared to arm B, respectively. Corresponding per protocol (PP) analysis indicates 2.2-fold (22.9% vs 10.6%, p=0.305) and 1.6-fold (22.9% vs 14.1%, p=0.448) higher uptakes in arm A compared to arm B. Screening uptake varied between communities (range 0\u201362.1%). Among women who completed a questionnaire (18.3% in arm A, 21.7% in arm B), the screening uptake was 1.8-fold (ITT; p=0.1132) or 3-fold (PP; p&lt;0.01) higher in arm A versus arm B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pap and HPV self-sampling were compared in a marginalised, Canadian population. Results indicated a preference for self-sampling. More research on how to reach underscreened Indigenous women is necessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ISRCTN84617261.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-011754","type":"journal-article","created":{"date-parts":[[2016,10,8]],"date-time":"2016-10-08T20:38:22Z","timestamp":1475959102000},"page":"e011754","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Community-randomised controlled trial embedded in the Anishinaabek Cervical Cancer Screening Study: human papillomavirus self-sampling versus Papanicolaou cytology"],"prefix":"10.1136","volume":"6","clinical-trial-number":[{"clinical-trial-number":"isrctn84617261","registry":"10.18810\/isrctn"}],"author":[{"given":"Ingeborg","family":"Zehbe","sequence":"first","affiliation":[{"name":"Probe Development and Biomarker Exploration, Thunder Bay Regional Research Institute (TBRRI), Thunder Bay, Ontario, Canada"},{"name":"Department of Biology, Lakehead University, Thunder Bay, Ontario, Canada"},{"name":"Northern Ontario School of Medicine, Clinical Sciences, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Jackson","sequence":"additional","affiliation":[{"name":"Probe Development and Biomarker Exploration, Thunder Bay Regional Research Institute (TBRRI), Thunder Bay, Ontario, Canada"},{"name":"Biotechnology Program, Lakehead University, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianne","family":"Wood","sequence":"additional","affiliation":[{"name":"School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Weaver","sequence":"additional","affiliation":[{"name":"Northern Ontario School of Medicine, Clinical Sciences, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Escott","sequence":"additional","affiliation":[{"name":"Northern Ontario School of Medicine, Clinical Sciences, Thunder Bay, Ontario, Canada"},{"name":"Department of Pathology and Laboratory Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Severini","sequence":"additional","affiliation":[{"name":"Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mel","family":"Krajden","sequence":"additional","affiliation":[{"name":"BC Centre for Disease Control, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Bishop","sequence":"additional","affiliation":[{"name":"Department of Biology, Lakehead University, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyla","family":"Morrisseau","sequence":"additional","affiliation":[{"name":"Department of Biology, Lakehead University, Thunder Bay, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Ogilvie","sequence":"additional","affiliation":[{"name":"BC Centre for Disease Control, Vancouver, British Columbia, Canada"},{"name":"School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann N","family":"Burchell","sequence":"additional","affiliation":[{"name":"Ontario HIV Treatment Network, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Little","sequence":"additional","affiliation":[{"name":"School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,10,8]]},"reference":[{"key":"2025121410075862000_6.10.e011754.1","unstructured":"Ferlay J , Soerjomataram I , Ervik M , et al . GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer, 2013. http:\/\/globocan.iarc.fr (accessed 21 Jun 2014)."},{"key":"2025121410075862000_6.10.e011754.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7188.904"},{"key":"2025121410075862000_6.10.e011754.3","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1016\/S1470-2045(15)00232-6","article-title":"Cancer incidence in indigenous people in Australia, New Zealand, Canada and the USA: a comparative population-based study","volume":"16","author":"Moore","year":"2015","journal-title":"Lancet Oncol"},{"key":"2025121410075862000_6.10.e011754.4","doi-asserted-by":"publisher","DOI":"10.1023\/A:1023632518568"},{"key":"2025121410075862000_6.10.e011754.5","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1503\/cmaj.110523","article-title":"Cervical cancer among Aboriginal women in Canada (Commentary)","volume":"18","author":"Demers","year":"2012","journal-title":"CMAJ"},{"key":"2025121410075862000_6.10.e011754.6","first-page":"135","article-title":"An investigation of cancer incidence in a First Nations community in Alberta, Canada, 1995\u20132006","volume":"30","author":"Colquhoun","year":"2010","journal-title":"Chronic Dis Can"},{"key":"2025121410075862000_6.10.e011754.7","doi-asserted-by":"publisher","DOI":"10.1057\/jphp.2012.8"},{"key":"2025121410075862000_6.10.e011754.8","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000669"},{"key":"2025121410075862000_6.10.e011754.9","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.489"},{"key":"2025121410075862000_6.10.e011754.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2015.07.006"},{"key":"2025121410075862000_6.10.e011754.11","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70354-7"},{"key":"2025121410075862000_6.10.e011754.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2010-000030"},{"key":"2025121410075862000_6.10.e011754.13","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3389\/fonc.2014.00027","article-title":"Using community engagement to inform and implement a community-randomized controlled trial in the Anishinaabek cervical cancer screening study","volume":"4","author":"Wood","year":"2014","journal-title":"Front Oncol"},{"key":"2025121410075862000_6.10.e011754.14","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-007-9165-7"},{"key":"2025121410075862000_6.10.e011754.15","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-69"},{"key":"2025121410075862000_6.10.e011754.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2013.06.005"},{"key":"2025121410075862000_6.10.e011754.17","first-page":"1","article-title":"Strategies for increasing cervical cancer screening amongst First Nations Communities in northwest Ontario, Canada","volume":"6","author":"Maar","year":"2014","journal-title":"Health Care Women Int"},{"key":"2025121410075862000_6.10.e011754.18","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1080\/09581596.2015.1067671","article-title":"Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study","volume":"26","author":"Wakewich","year":"2015","journal-title":"Crit Public Health"},{"key":"2025121410075862000_6.10.e011754.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7441.702"},{"key":"2025121410075862000_6.10.e011754.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e5661"},{"key":"2025121410075862000_6.10.e011754.21","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00583"},{"key":"2025121410075862000_6.10.e011754.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586"},{"key":"2025121410075862000_6.10.e011754.23","unstructured":"Aboriginal Affairs and Northern Development Canada. 2013 Indian Registration System (Communities, Age, Gender) [database]. https:\/\/www.aadnc-aandc.gc.ca\/eng\/1291132820288\/1291132853616#stats (accessed 15 Jul 2014)."},{"key":"2025121410075862000_6.10.e011754.24","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)35242-2"},{"key":"2025121410075862000_6.10.e011754.25","doi-asserted-by":"crossref","first-page":"243","DOI":"10.2340\/00015555-0205","article-title":"High prevalence of oncogenic human papillomavirus in women not attending organized cytological screening","volume":"87","author":"Stenvall","year":"2007","journal-title":"Acta Derm Venereol"},{"key":"2025121410075862000_6.10.e011754.26","doi-asserted-by":"publisher","DOI":"10.1080\/00016340701303747"},{"key":"2025121410075862000_6.10.e011754.27","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605194"},{"key":"2025121410075862000_6.10.e011754.28","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19960615)15:11<1069::AID-SIM220>3.0.CO;2-Q"},{"key":"2025121410075862000_6.10.e011754.29","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/20.1.77"},{"key":"2025121410075862000_6.10.e011754.30","unstructured":"Redmond C , Colton T . Biostatistics in clinical trials. New York: John Wiley and Sons Ltd, 2008:56."},{"key":"2025121410075862000_6.10.e011754.31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000065"},{"key":"2025121410075862000_6.10.e011754.32","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-10"},{"key":"2025121410075862000_6.10.e011754.33","doi-asserted-by":"publisher","DOI":"10.1177\/1740774512450098"},{"key":"2025121410075862000_6.10.e011754.34","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3370"},{"key":"2025121410075862000_6.10.e011754.35","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1472-6939-15-28","article-title":"Screening: the information individuals need to support their decision: per protocol analysis is better than intention-to-treat analysis at quantifying potential benefits and harms of screening","volume":"15","author":"Rossi","year":"2014","journal-title":"BMC Medical Ethics"},{"key":"2025121410075862000_6.10.e011754.36","doi-asserted-by":"crossref","unstructured":"Davison AC , Hinkley DV . Bootstrap methods and their application. Chapter 5. Cambridge, UK: Cambridge University Press, 1997.","DOI":"10.1017\/CBO9780511802843"},{"key":"2025121410075862000_6.10.e011754.37","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-004-8146-5"},{"key":"2025121410075862000_6.10.e011754.38","doi-asserted-by":"publisher","DOI":"10.1080\/08870440902822913"},{"key":"2025121410075862000_6.10.e011754.39","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2832"},{"key":"2025121410075862000_6.10.e011754.40","unstructured":"Howell D . Treatment of ordered variables in a contingency table. 2007. http:\/\/www.uvm.edu\/~dhowell\/methods7\/Supplements\/OrdinalChiSq.html (accessed 24 Apr 2015)."},{"key":"2025121410075862000_6.10.e011754.41","unstructured":"Germain MF , Costa R , Kelly-Scott K . 2006 Aboriginal population profile for Thunder Bay (component of statistics canada catalogue no. 89-638-X no. 2009001). Apr 2009. http:\/\/www.statcan.gc.ca\/pub\/89-638-x\/2009001\/article\/10832-eng.pdf (accessed 26 Jul 2015)."},{"key":"2025121410075862000_6.10.e011754.42","unstructured":"Urban Aboriginal Population Study: Environics Institute, 2011. http:\/\/www.uaps.ca\/wp-content\/uploads\/2010\/02\/UAPS_Summary_Final.pdf (accessed 29 Jul 2015)."},{"key":"2025121410075862000_6.10.e011754.43","unstructured":"Statistics Canada. Health Fact Sheets (Publication 82-625-X). Household Food Insecurity. 2013. http:\/\/www.statcan.gc. ca\/pub\/82-625-x\/2013001\/article\/11889-eng.htm (accessed 27 Apr 2014)."},{"key":"2025121410075862000_6.10.e011754.44","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1007\/BF03405681","article-title":"Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta-analysis","volume":"104","author":"Racey","year":"2013","journal-title":"Can J Public Health"},{"key":"2025121410075862000_6.10.e011754.45","unstructured":"Cancer Care Ontario, Toronto: Screening Guidelines 2014. Toronto. https:\/\/www.cancercare.on.ca\/pcs\/screening\/cervscreening\/screening_guidelines\/ (accessed 26 Jul 2015)."},{"key":"2025121410075862000_6.10.e011754.46","unstructured":"Sameshima P , Slingerland D , Wakewich P , et al . Growing wellbeing through community participatory arts: the Anishinaabek Cervical Cancer Screening Study (ACCSS). The Palgrave Handbook of Global Arts Education. In press."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2016-011754","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T18:08:07Z","timestamp":1765735687000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2016-011754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2016,10,8]]},"published-print":{"date-parts":[[2016,10]]}},"alternative-id":["10.1136\/bmjopen-2016-011754"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2016-011754","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10]]}}}