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Increasing cervical cancer screening uptake in older women: the SHOW2 trial

Female hands

Cervical cancer screening done by a nurse or doctor without the use of a speculum, as well as giving patients the opportunity to self-sample, increased screening uptake among older women who had missed smear test appointments, research has shown.

In the SHOW2 study, which recruited entirely from GP practices in the North Thames region, women aged 50-64 either received standard care in which they were sent the usual smear test reminder letters, or the intervention arm of the trial, which was a letter offering them the choice of having a sample taken by a doctor or nurse without using a speculum or a self-sampling kit.

“We know that the speculum is a key barrier to cervical screening and after the menopause it can make screening particularly uncomfortable,” explained Dr Anita Lim, Senior Epidemiologist in the Cancer Prevention Group at King's College London, who led the study.

“This is mostly because of hormonal changes that happen during the menopause, and we thought that this could be a reason why some women haven’t been coming for screening as they get older.

“Cervical cancer disproportionately affects women aged 65 and over, especially those who haven’t been regularly screened from age 50. We know that regular screening prevents cervical cancer from developing so it’s really important that we get more women screened.”

In the study, nearly 800 women were randomised from 10 GP practices in the boroughs of Tower Hamlets, City and Hackney. It was shown that offering non-speculum and self-sampling led to a significant increase in screening uptake, that was 17% higher than uptake in women who received usual care. Increased uptake was seen across all ethnic backgrounds.

Giving women the choice of how they want to be screened could also be important in boosting cervical cancer screening rates in future, the researchers said.

Noclor, a partner organisation of CRN North Thames, helped the researchers identify suitable GP practices and supported them to set up additional smear clinics for the study.

“Noclor put us in touch with practices we had worked with on previous studies but also some new ones,” said Dr Lim. “Noclor also helped us get responses from the GP practices who can be very busy. We are very grateful to them for their help.”

The results from the study have been published in the British Journal of General Practice.