Discussion
pain
SECONDARY, CERVICAL CANCER
In this study, which was a secondary analysis of the ACCESS trial, we revealed the main reasons for not undergoing cervical cancer screening, the degree of knowledge about HPV before and after participating in this trial, the acceptability of self-sampling, and future screening preference.Previous studies reported that the main reasons for not having a cytology test were practical barriers, such as a lack of time to undergo the test and forgetting to schedule an appointment, and emotional barriers, such as embarrassment, discomfort, and pain [Acceptability of the self-sampling HPV test was favorable. This result is consistent with many previous studies across various countries [Knowledge about HPV increased after participating in this trial, suggesting that experience of the self-sampling HPV test improved knowledge. We also found a significant association between longer duration without screening and less knowledge before participating in this trial; however, the association disappeared after participation. Previous studies reported evidence of disparity with regard to women’s knowledge about HPV; the knowledge was less among women whose cervical cancer mortality was disproportionately high, including racial and ethnic minorities and those with low socioeconomic status [As for future screening preference, screening with self-collected samples was preferred over that with doctor-collected samples, which is consistent with previous studies [Additionally, older age and longer duration without screening were associated with a lower willingness to undergo screening with doctor-collected samples, but these associations were not observed in the screening with self-collected samples. In all subgroups, approximately 90% of participants were willing to undergo screening with self-collected samples. A comparison between age and impressions of the self-sampling test revealed that older women more frequently experienced pain and were less likely to feel that self-sampling was easy compared with younger women. Nonetheless, most older women seemed to prefer the self-sampling method. These results suggest that the self-sampling HPV test is an acceptable method regardless of age and the duration without screening and may result in reducing disparities in screening rates.A major limitation of this study is the low proportion of participants who underwent the self-sampling HPV test, that is 16.3% of the eligible women. This affects the interpretation of the results. First, even if the acceptability of the test is favorable, under the assumed situation that the screening uptake in the self-sampling group is lower than that in the control group, the self-sampling HPV test is useless. This trial is ongoing. Therefore, conclusions about the effectiveness of the self-sampling HPV test must await the results of the primary endpoint. However, given that the subjects of this trial were women who had not received cervical cancer screening for three or more years, this participation rate is thought to be meaningful. Additionally, the previous studies observed similar participation rates [In conclusion, this study reveals high acceptability and preference for the self-sampling HPV test among women who used the test and adds further evidence to strengthen a hypothesis that the test is acceptable to women across cultures and countries. Additionally, this study suggests that the self-sampling HPV test reduces disparities in knowledge about HPV and screening rates. Thus, this study provides useful evidence to decision-makers to implement the self-sampling HPV test as a practice in Japan, where cervical cancer prevention measures are seriously lacking.