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The overall aim of the study is to increase participation rates in cervical cancer (CCU) and colorectal cancer (CRC) screening programmes in Denmark by offering home-based CCU and CRC screening to women who are overdue for one or both screening programmes when attending breast cancer screening
A cluster-randomised public health trial will take place in Central Denmark Region (CDR) targeting women attending breast cancer screening. Five breast cancer screening units serve women five days a week, and all five units will be included in the study and randomly allocated to an equal amount of intervention days. On the intervention days, the other four units will serve as the control group, providing a randomisation ratio of 1:4.
On the intervention days, a research assistant will ask the women aged 50-69 years if they are interested in having a check up on their screening status with CCU and CRC screening. If the woman has not participated timely, she will be offered to receive a test-kit corresponding to CRC screening and/or to receive a self-sample device for CCU screening (or reminded to call her general practitioner (GP) to have a conventional cervical cytology sample taken).
If the woman accepts a self-sample kit for CCU and/or CRC screening, she will receive it by mail together with written instructions, picturebased user instructions, information on national recommendation for cancer screening and a pre-paid, pre-addressed envelope for returning the sample to the laboratory.
The result of the test will be sent to the women by digital mail as well as passed on to her GP.
Clinical management in case of a positive test result will follow national guidelines corresponding to CCU and CRC screening programmes.
Women in the control group will receive standard screening offers according to the national screening programmes.
All women entering a breast cancer screening unit in CDR on a intervention day (intervention + control units) will be sent a survey asking their experience with breast cancer screening a few days after breast cancer screening. The women in the intervention group will be asked about the acceptability of the intervention as well.
27500 women must be included, of which 5500 women will be in the intervention group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | All women aged 50-69 years attending breast cancer screening in the intervention unit on an intervention day. They will all be offered to receive information on their screening status in cervical cancer og colorectal cancer screening. Women aged 50-64 years, who have not had a cervical cytology sample taken within 5 years and 6 months will be offered to receive a self-sample device for high risk human papilloma virus (hrHPV) screening by mail, or reminded to see her general practitioner (GP) to have a conventional cervical cytology sample taken. Women aged 50-69 years, who have not had a Faecal Immunochemical Test (FIT) within 2 years and 4.5 months will be offered to receive a new self-sampling kit for FIT. |
|
| Control group | No Intervention | Women in the control group will receive standard screening offers according to the national screening programme. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Screening status | Behavioral | Women are offered check-up on screening status in both CCU and CRC screening. If a woman is not up to date in one or both screening programmes, she will be offered a self-sampling device and/or a FIT kit. |
| Measure | Description | Time Frame |
|---|---|---|
| Coverage | Difference in overall coverage og CCU/CRC screening six months after the intervention between control and intervention group | 180 days after participating in breast cancer screening |
| Participation | Difference between intervention and control group in proportion of women participating in CCU and CRC screening after 180 days for those overdue with CCU/CRC screening at the intervention | 180 days after participating in breast cancer screening |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of hrHPV in self-samples in CCU screening | After study completion, expected to be 1 year | |
| Rate of compliance to follow-up in CCU screening | A GP collected sample after a hrHPV positive self-sample |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of women accepting a check up on CCU and CRC screening status | Process outcome within the intervention group | At end of enrollment |
| Proportion of women overdue with CCU and/or CRC screening |
Inclusion Criteria:
Women aged 50-69 years attending breast cancer screening in Central Denmark Region on selected days.
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| Name | Affiliation | Role |
|---|---|---|
| Berit Andersen, Prof., MD, Head of Department | Department of Public Health Programmes and University Clinic for Cancer Screening, Randers Regional Hospital and Department of Clinical Medicine, Aarhus University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Anne Dorte Lerche Helgestad | Randers | 8930 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39137185 | Derived | Helgestad ADL, Larsen MB, Njor S, Tranberg M, Petersen LK, Andersen B. Increasing coverage in cervical and colorectal cancer screening by leveraging attendance at breast cancer screening: A cluster-randomised, crossover trial. PLoS Med. 2024 Aug 13;21(8):e1004431. doi: 10.1371/journal.pmed.1004431. eCollection 2024 Aug. | |
| 36137619 |
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| ID | Term |
|---|---|
| D002583 | Uterine Cervical Neoplasms |
| D015179 | Colorectal Neoplasms |
| ID | Term |
|---|---|
| D014594 | Uterine Neoplasms |
| D005833 | Genital Neoplasms, Female |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
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| Within 180 days after a positive hrHPV self-sample |
| Register-based screening history of self-samplers in CCU screening | "Under-screened" defined as screened at least once with in the last 10 years prior to the intervention. "Un-screened" defined as no screening sample with in the last 10 years prior to the intervention. | After test completion. expected to be 1 year |
| Prevalence of colposcopies after CCU screening | Within 180 days after a positive hrHPV self-sample |
| Incidence of CIN2+ | Within 180 days after a positive hrHPV self-sample |
| Incidence of hrHPV positive cases in women 60-64 years after 12 months with an initial negative hrHPV sample in CCU screening | After test completion, expected to be 1 year |
| Prevalence of positive FIT cases after CRC screening for those overdue at the intervention date | After test completion, expected to be 1 year |
| Histology (number of adenomas, cancer) after a positive FIT in CRC screening | After test completion, expected to be 1 year |
| Register-based screening history in CRC screening | "Under-screened" defined as at least one FIT, but none with the last 2 years and 4.5 months. "Un-screened" defined as no previous FIT despite invitation | After test completion, expected to be 1 year |
| Rate of compliance to follow-up with colonoscopy after a positive FIT | Within 60 days from a positive FIT |
Process outcome within the intervention group
| At end of enrollment |
| Proportion of women accepting a test-kit | Process outcome within the intervention group | At end of enrollment |
| Proportion of women not returning a test kit | Process outcome within the intervention group | At end of enrollment |
| Previous screening history, previous cancer diagnoses, socioeconomic data (age, ethnicity, marital status, educational status) and inflammatory bowel disease | To test if the randomisation succeeded | At end of enrollment |
| Survey evaluation | Evaluation regarding the acceptability of the intervention | At end of enrollment |
| Helgestad ADL, Larsen MB, Njor S, Tranberg M, Petersen LK, Andersen B. Three birds with one stone: a protocol for a randomised intervention study to increase participation in cervical and colorectal cancer screening among women attending breast cancer screening. BMJ Open. 2022 Sep 22;12(9):e062824. doi: 10.1136/bmjopen-2022-062824. |
| D009369 |
| Neoplasms |
| D002577 | Uterine Cervical Diseases |
| D014591 | Uterine Diseases |
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D000091662 | Genital Diseases |
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |