High uptake and adherence to cervical cancer screening among older French women based on a midwife-led outreach strategy and vaginal self-sampling: results from the RIDECA study

The acceptability and effectiveness of the invitation strategies using self-sample devices for cervical cancer screening are critical before further implementation. In France, participation of older women in cervical cancer screening remains low, and studies evaluating outreach strategies to propose self-sampling are lacking. The RIDECA project is prospective single-arm interventional study. The primary objective was to evaluate uptake of cervical cancer screening among under-screened older women, using a midwife-led outreach strategy to offer a self-sampling device. Women aged 50 to 65 years with no cervical cancer screening in the last three years were offered a vaginal self-sampling device by the midwife to use at home with a pre-stamped return envelope. The project was implemented in two locations in the south of France. At site 1, women were recruited by a midwife while attending a mobile unit for breast cancer screening. In site 2, the midwife offered women easy appointments or approached them in various locations following a communication campaign. Women with a positive HR-HPV result were asked to undergo cervical cytology testing. During recruitment, participants completed a questionnaire about their socio-economic circumstances. Statistical analyses were conducted for the full research sample and for each recruitment site. From September 2021 to July 2023, a total of 705 women were invited by a midwife to participate in the RIDECA study and benefit from a self-sample device. Recruitment was more efficient at site 1 than at site 2. The uptake rate (proportion of targeted women who accepted the self-sampling device proposed by the midwife) was found to be 92.75%. Of these women, 74.2% performed self-sampling and returned the device to the laboratory, most of them (86%) doing so spontaneously. The proportion of self-samples testing positive for HR-HPV was 7.8% and 94.3% of this population completed follow-up. The RIDECA outreach strategy demonstrated high levels of both uptake and adherence. It also showed that mobile units, like those used for breast cancer screening, could encourage uptake of cervical cancer screening. Further studies are required to confirm these initial findings and replicate the approach in other contexts and with other under-screened populations. ClinicalTrials.gov (NCT04716127), 20 January 2021.