***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : In Italy , cervical cancer screening programmes actively invite women aged 25–64 years . Programmes are hindered by low participation . Methods : A sample of non-responder women aged 35–64 years , belonging to three different programmes ( in Rome , Florence and Teramo ) , was r and omly split into four arms : two control groups received st and ard recall letters to perform either Pap-test ( first group ) or human papillomavirus ( HPV ) test ( second group ) at the clinic . A third arm was sent letters offering a self- sample r for HPV testing , to be requested by phone , whereas a fourth group was directly sent the self- sample rs home . Results : Compliance with st and ard recall was 13.9 % ( N619 ) . Offering HPV test at the clinic had a nonsignificant effect on compliance ( N616 , relative risk (RR)=1.08 ; 95 % CI=0.82–1.41 ) . Self- sample r at request had the poorest performance , 8.7 % ( N622 , RR=0.62 ; 95 % CI=0.45–0.86 ) , whereas direct mailing of the self- sample r registered the highest compliance : 19.6 % ( N616 , RR=1.41 ; 95 % CI=1.10–1.82 ) . This effect on compliance was observed only in urban areas , Florence and Rome ( N438 , RR=1.69 ; 95 % CI=1.24–2.30 ) , but not in Abruzzo ( N178 , RR=0.95 ; 95 % CI=0.61–1.50 ) , a prevalently rural area . Conclusions : Mailing self- sample rs to non-responders may increase compliance as compared with delivering st and ard recall letters . Nevertheless , effectiveness is context specific and the strategy costs should be carefully considered Cervical cancer is more common in the Somali immigrant population than the general population in the United States ( US ) . There are low rates of cervical cancer screening among Somali women . This study compares cervical cancer screening test completion rates for a home human papilloma virus ( HPV ) test and st and ard clinic Pap test .  Sixty‐three Somali immigrant women aged 30–70 years who had not undergone cervical cancer screening within the past 3 years were r and omly assigned to a home HPV test group ( intervention ) or a clinic Pap test group ( control ) .  Test completion rates were measured at 3 months . Univariate and multivariate logistic regression models were used to explore factors associated with test completion ( intention‐to‐treat analysis ) . Participants in the HPV test group were 14 times more likely to complete the test compared to those in the Pap test group ( P = 0.0002 ) . Women who reported having friends/family members to talk about cancer screening were approximately three times more likely to complete any screening test than those who did not ( P = 0.127 ) and participants who reported residing in the US longer were more likely to complete a screening test ( P = 0.011 ) . Future research should explore the potential of using the home‐based HPV test kits as an initial approach to cervical cancer screening . Impact : The use of a self‐sampling HPV kit has the potential to increase cervical cancer screening in under‐served communities in the US Background : A r and omised trial to ascertain whether women who do not attend for cervical screening are more likely to respond to the opportunity to collect a self- sample for human papillomavirus ( HPV ) testing , or to a further invitation to attend for cervical screening . Methods : The study was carried out in a Primary Care Trust ( PCT ) in London between June 2009 and December 2009 . In total , 3000 women were r and omly selected from persistent non-responders ( i.e. , who had not responded to at least two invitations to attend for screening ) . The women were r and omised on a 1 : 1 basis to either receive an HPV self-sampling kit or a further invitation to attend for cervical cytology . The main outcome measures were ( 1 ) percentage of women attending for cervical cytology compared with those returning a self- sample HPV test or attending for cytology subsequent to receiving the kit and ( 2 ) percentage of those testing positive for HPV who attended further investigation . Results : The total response in the self-sampling group for screening was 10.2 % . Of the 1500 women in the control group sent a further invitation for cervical screening , 4.5 % attended for cytology screening . This difference is highly statistically significant ( P<0.0001 ) . Of the 8 women who tested positive for HPV , 7 attended for a cervical smear and had a concurrent colposcopy . Three of these ( 43 % ) had high- grade disease ( defined as CIN 2 + ) , with one found to have an invasive cancer ( stage 1b ) and one CIN 3 . Conclusions : The value of this intervention relies on the detection of high- grade CIN and early stage cancer with a good prognosis . The relatively high yield of abnormalities found is consistent with that expected among a hard to reach and relatively high-risk group of women . Our study suggests that self-sampling could increase participation among non-responders in Engl and , but further work is needed to ascertain whether the low response rate seen here is likely to be representative of the rest of the country . Other studies are needed to investigate the response to self-sampling in different demographic and geographic setting Objectives The incidence of cervical cancer is up to 20-fold higher among First Nations women in Canada than the general population , probably due to lower participation in screening . Offering human papillomavirus ( HPV ) self-sampling in place of Papanicolaou ( Pap ) testing may eventually increase screening participation and reduce cervical cancer rates in this population . Design A community-r and omised controlled screening trial . Setting First Nations communities in Northwest Ontario , Canada . Participants Women aged between 25 and 69 , living in Robinson Superior Treaty First Nations . The community was the unit of r and omisation . Interventions Women were asked to complete a question naire and have screening by HPV self-sampling ( arm A ) or Pap testing ( arm B ) . Primary outcome measures The number of women who participated in cervical screening . R and omisation Community clusters were r and omised to include approximately equivalent numbers of women in each arm . Results 6 communities were r and omised to arm A and 5 to arm B. One community withdrew , leaving 5 communities in each group ( 834 eligible women ) . Participation was < 25 % . Using clustered intention-to-treat ( ITT ) analysis , initial and cumulative averaged uptakes in arm A were 1.4-fold ( 20 % vs 14.3 % , p=0.628 ) and 1.3-fold ( 20.6 % vs 16 % , p=0.694 ) higher compared to arm B , respectively . Corresponding per protocol ( PP ) analysis indicates 2.2-fold ( 22.9 % vs 10.6 % , p=0.305 ) and 1.6-fold ( 22.9 % vs 14.1 % , p=0.448 ) higher uptakes in arm A compared to arm B. Screening uptake varied between communities ( range 0–62.1 % ) . Among women who completed a question naire ( 18.3 % in arm A , 21.7 % in arm B ) , the screening uptake was 1.8-fold ( ITT ; p=0.1132 ) or 3-fold ( PP ; p<0.01 ) higher in arm A versus arm B. Conclusions Pap and HPV self-sampling were compared in a marginalised , Canadian population . Results indicated a preference for self-sampling . More research on how to reach underscreened Indigenous women is necessary . Trial registration number IS RCT N84617261 Background Cervical cancer screening participation remains insufficient in most countries . Our aim was to evaluate whether offering a HPV self-sampling kit , either mailed directly to the woman ’s home or using timely opt-in procedures for ordering the kit , increased screening participation compared with a st and ard second reminder . Methods In this r and omized , controlled effectiveness trial , 9791 Danish women aged 30–64 who were due to receive the second reminder were equally r and omized to either : 1 ) direct mailing of a second reminder and a self-sampling kit ( directly mailed group ) ; 2 ) mailing of a second reminder that offered a self-sampling kit to be ordered by e-mail , text message , phone , or webpage ( opt-in group ) ; or 3 ) mailing of a second reminder to attend regular cytology screening ( control group ) . In an intention-to-treat analysis , we estimated the participation rate at 180 days post intervention , by returning a self- sample or attending regular cytology screening . We calculated the proportion of women with a positive HPV self- sample who attended for cervical cytology triage at the general practitioner within 90 days . Results Participation was significantly higher in the directly mailed group ( 38.0 % ) and in the opt-in group ( 30.9 % ) than in the control group ( 25.2 % ) ( participation difference ( PD ) : 12.8 % , 95 % CI : 10.6–15.0 % and PD : 5.7 % , 95 % CI : 3.5–7.9 % , respectively ) . Within 90 days , 107 women ( 90.7 % , 95 % CI : 83.9–95.3 % ) with a HPV-positive self- sample attended follow-up . Conclusions Offering the opportunity of HPV self-sampling as an alternative to regular cytology screening increased participation ; the direct mailing strategy was the most effective invitation strategy . A high compliance with follow-up was seen . Trial registration Current Controlled Trials NCT02680262 . Registered 10 February 2016 Background Ethnic minority women are at increased risk of cervical cancer .  Self-sampling for high-risk human papillomavirus ( HPV ) is a promising approach to increase cervical screening among hard-to-reach population s. Objective To compare a community health worker (CHW)-led HPV self-sampling intervention with st and ard cervical cancer screening approaches . Design A 26-week single-blind r and omized pragmatic clinical trial . Participants From October 6 , 2011 to July 7 , 2014 , a total of 601 Black , Haitian , and Hispanic women aged 30–65 years in need of cervical cancer screening were recruited , 479 of whom completed study follow-up . Interventions Participants were r and omized into three groups : ( 1 ) outreach by CHWs and provision of culturally tailored cervical cancer screening information ( outreach ) , ( 2 ) individualized CHW-led education and navigation to local health care facilities for Pap smear ( navigation ) , or ( 3 ) individualized CHW-led education with a choice of HPV self-sampling or CHW-facilitated navigation to Pap smear ( self-swab option).Main Measures The proportion of women in each group whom self-reported completion of cervical cancer screening . Women lost to follow-up were considered as not having been screened . Key Results Of the 601 women enrolled , 355 ( 59 % ) were Hispanic , 210 ( 35 % ) were Haitian , and 36 ( 6 % ) were non-Haitian Black . In intent-to-treat analyses , 160 of 207 ( 77 % ) of women in the self-swab option group completed cervical cancer screening versus 57 of 182 ( 31 % ) in the outreach group ( aOR 95 % CI , p < 0.01 ) and 90 of 212 ( 43 % ) in the navigation group ( aOR CI , p = 0.02 ) . Conclusions As compared to more traditional approaches , CHW-facilitated HPV self-sampling led to increased cervical cancer screening among ethnic minority women in South Florida . Trial Registration Clinical Trials.gov Identifier : We conducted a r and omized , controlled trial to evaluate different strategies of offering an HPV-self sampling program , and compared this with two control groups . All total of 35,354 women who did not participate in the Flemish cancer screening program were included in the study : 9,118 received a  HPV self- collection brush ( RIATOL qPCR HPV genotyping test ( qPCR [ E6/E7 ] ) ;  9,098 were offered the opportunity  to order an HPV-selfsampling brush , 8,830 received the recall letter ; 8,849 received no intervention . Within 12 months after the mailing , 18.7 % of the women who had received the brush , participated by returning a  self- sample sample  , while 10.6 % women allocated to the opt- in group did so . 10.5 % women who received the st and ard recall letter , had a PAP smear taken within a period of 12 months ; while 8 % women did so without receiving an intervention at all .  Participation in postmenopausal women was higher than in women younger than 50 in both self-sampling arms . Screening by means of the self- sample kit  increased by age , contradictory when screening is performed by a PAP smear . Of those testing hrHPV positive ( 9.5 % ) , 88.9 % attended for follow up cytology . The mean DNA concentration , found in the self- sample r , decreased by age , causing a higher number of inconclusive results . Our results support the efficacy of a  self-sampling strategy  to increase participation in 
    Output:
    
Conclusion A growing evidence base , mainly from high-income countries and with significant heterogeneity , suggests HPV self-sampling can increase cervical cancer screening uptake compared with st and ard of care , with a marginal effect on linkage to clinical assessment /treatment .