Self-sampling HPV test in women not undergoing Pap smear for more than 5 years and factors associated with under-screening in Taiwan

Hung Hsueh Chou, Huei Jean Huang, Hui Hsin Cheng, Chee Jen Chang, Lan Yan Yang, Chu Chun Huang, Wei Yang Chang, Swei Hsueh, Angel Chao, Chin Jung Wang, Yun Hsin Tang, Cheng Tao Lin, Jian Tai Qiu, Min Yu Chen, Chao Yu Chen, Kuan Gen Huang, Tzu Chun Tsai, Ting Chang Chang, Chyong Huey Lai

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5 Citations (Scopus)


Background/Purpose Under-utilization of Papanicolaou (Pap) smear causes a gap in the prevention of cervical neoplasms. A prospective population-based study was conducted investigating whether a self-sampling human papillomavirus (HPV) test was feasible for under-users of Pap smear and factors associated with under-screening in Taiwan. Methods Women not having Pap smear screening for > 5 years were invited to participate in this study. Invitation letters and educational brochures were mailed to 4% of randomly selected eligible women from Taoyuan City, Taiwan, and responders received an HPV self-sampling kit. Those with HPV-positive results were recalled for a Pap smear and colposcopy. Results Between March 2010 and June 2012, 10,693 women were invited, 354 responded (3.3%), and 282 (2.6%) gave valid informed consent, answered the questionnaire, and submitted HPV samples. The median age of enrolled women was 48.1 years. Forty-seven women (16.7%) had a positive HPV test, and 14 women accepted further survey to find two CIN2+. Another two cases of CIN2+ were identified from a national registry database. The cost of direct mailing self-samplers was less than that done on request (from NT$434,866 to NT$164,229, response rate of 5% to 15%, respectively, versus NT$683,957 for detecting 1 CIN2+). Reasons for not attending screening included lack of time, embarrassment, assumed low risk, fear of positive results, and perceived potential pain. Among the responders, 90.8% found the method acceptable. Conclusion Our study indicated that different approaches (e.g., direct mailing self-samplers to under-users and/or various educational interventions) must be explored to improve coverage in populations with culture characteristics similar to Taiwan.

Original languageEnglish
Pages (from-to)1089-1096
Number of pages8
JournalJournal of the Formosan Medical Association
Issue number12
Publication statusPublished - Dec 1 2016
Externally publishedYes


  • cervical neoplasms
  • human papillomavirus
  • Pap smear
  • screening rate
  • self-sampling

ASJC Scopus subject areas

  • Medicine(all)


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