• Adino Tesfahun Tsegaye, Rachel L Winer, Allison Cole, Adam A Szpiro, Judd Walson, and Darcy W Rao.
• Department of Epidemiology, University of Washington School of Public Health, Seattle; USA. Electronic address: adino@uw.edu.
• Am J Prev Med. 2024 Nov 29.

IntroductionCervical cancer screening uptake among East African immigrants (EAI) in the US is low. Offering self-collected samples for human papillomavirus (HPV) testing increases screening coverage among underserved populations, but the potential impact on cervical cancer incidence and mortality is understudied.MethodsA Markov cohort state-transition model was used to predict the impact of primary HPV screening with self-sampling on cervical cancer incidence and mortality among EAI women in Washington state. The model estimated cervical cancer cases and deaths for a hypothetical cohort from ages 25-80 years under alternative screening, diagnostic colposcopy and treatment scenarios. Base case scenarios compared primary HPV testing by clinician-sampling exclusively (standard-of-care, SOC) with self-sampling exclusively, assuming higher screening coverage (70% vs. 63%) but lower colposcopy adherence with self-sampling (67% vs. 83%) with equal treatment coverage of 85%, based on Washington state patient data. Sensitivity analyses with varied coverages, and also the combinations of the two strategies were evaluated. The model was developed and fitted between 2022 and 2024 RESULTS: In the base case scenario, an exclusive self-sampling strategy results in 4% higher cervical cancer incidence and mortality compared to the SOC. Self-sampling results in lower cancer incidence and mortality if colposcopy adherence is raised to the level of the SOC and/or if coverage is increased beyond 90%. In scenarios combining clinician- with self-sampling, the benefits of reaching more women with self-sampling are attenuated if more than 34% of screening is done by self-sampling.ConclusionsSelf-sampling has the potential to improve cervical cancer prevention for underserved populations. The impact of the strategy can be enhanced with stronger linkage to follow-up care.Copyright © 2024. Published by Elsevier Inc.

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