***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: OBJECTIVE To determine the factors associated with participation in cervical cancer screening and follow-up treatment in the context of a r and omized controlled trial . The trial was initiated to evaluate the efficacy and cost effectiveness of visual inspection with acetic acid , cytological screening and testing for human papillomavirus in reducing the incidence of and mortality from cervical cancer in Maharashtra , India . METHODS Between October 1999 and November 2003 women aged 30 - 59 years were r and omized to receive one of the  three tests  or to a  control group . Participation was analysed for all three intervention arms . The differences between those who were screened versus those who were not was analysed according to the sociodemographic characteristics of the 100,800 eligible women invited for screening . Those who were treated versus those who were not were analysed according to the sociodemographic characteristics of the 932 women diagnosed with high- grade lesions .  Participation in screening and compliance with treatment were also analysed according to the type of test used . FINDINGS Compared with women who were not tested , screened women were younger ( aged 30 - 39 ) , better educated and had ever used contraception . A higher proportion of screened women were married and a lower proportion had never been pregnant . Of the 932 women diagnosed with high- grade lesions or invasive cancer , 85.3 % ( 795 ) received treatment . Women with higher levels of education , who had had fewer pregnancies and those who were married were more likely to comply with treatment . There were no differences in rates of screening or compliance with treatment when results were analysed by the test received . CONCLUSIONS Irrespective of the test being used , good participation levels for cervical cancer screening can be achieved in rural areas of developing countries by using appropriate strategies to deliver services . Communication methods and delivery strategies aim ed at encouraging older , less-educated women , who have less contact with reproductive services , are needed to further increase screening uptake 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 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 We evaluated the effect of offering brush-based vaginal self-sampling for high-risk human papillomavirus ( hrHPV ) testing to non-attendees of the cervical screening program on response rate , compliance to follow-up and cervical intraepithelial neoplasia grade 2 or 3 ( CIN2+/CIN3 + ) yield . In addition , concordance of hrHPV test results between physician-taken cervical scrapes and vaginal self- sample s was determined . A total of 26,409 nonattending women were r and omly assigned to receive a vaginal brush device for hrHPV testing by Hybrid Capture-2 method ( i.e. , self-sampling group , n = 26,145 ) or a reinvitation for regular cytology-based screening ( i.e. , recall control group , n = 264 ) . hrHPV-positive self-sampling responders were invited for a physician-taken scrape for cytology and blinded hrHPV testing . If cytology was abnormal , women were referred for colposcopy . Response rate in the self-sampling group was significantly increased compared to the recall control group ( 30.8 % versus 6.5 % ; p < 0.001 ) . The concordance rate between hrHPV detection in self- sample s and corresponding physician-taken cervical scrape sample s was 68.8 % . Amongst women with CIN3 + and CIN2 + , the concordance rates in hrHPV positivity between both sample s were 95.5 % and 93.8 % , respectively . Adherence at baseline to cytology triage of hrHPV-positive self-sampling women ( 89.1 % ) and colposcopy referral of those with abnormal cytology ( 95.8 % ) was high . The CIN2+/CIN3+/carcinoma yields were 1.5 % , 1.0 % and 0.1 % , respectively , in self-sampling responders . In conclusion , offering hrHPV testing on self- sample d vaginal material with a brush device to non-attendees significantly increases the attendance to the regular screening program , yields hrHPV test results that are in very good concordance with those of physician-taken scrapes in women with CIN2+/CIN3 + , and is effective in detecting CIN2+/CIN3 + Background : Attendance in screening is an important determinant of cervical cancer . Previous experience on high-risk human papillomavirus ( hrHPV ) DNA testing on patient-obtained sample s suggests a good effect among nonattendees of screening . We assessed the effects of self-sampling on attendance in the Finnish screening program . Methods : Nonattendees after the primary invitation in one municipality ( Espoo ) were r and omized to receive either a self-sampling kit ( 2,397 women ) or an extra invitation ( 6,302 women ) . One fourth ( 1,315 women ) of reminder letter arm nonattendees also received a self-sampling kit as a third intervention . Main outcomes were increases in screening attendance and coverage . Results : The adjusted relative risk for participation by  self-sampling  as a second intervention in comparison to a reminder letter arm was 1.21 ( 95 % CI : 1.13–1.30 ) . Total attendance increased from 65 % to 76 % by self-sampling and from 65 % to 74 % with a reminder letter . Combining the interventions ( reminder letter and then self-sampling )  increased total attendance from 63 % to 78 % . One fifth of the participants in all three groups increased screening coverage ( previous Pap smear ≥5 years ago or never ) . Self-obtained sample s were more often HPV positive than provider-obtained ones ( participants after primary invitation and reminder letter ) , 12 % to 13 % versus 7 % . Conclusions : Self-sampling is a feasible option in enhancing the attendance at organized screening , particularly as an addition to a reminder letter . Impact : If self-sampling is used as a third intervention after two written invitations , the overall attendance in Finl and could most likely reach the desired 80 % to 85 % . Cancer Epidemiol Biomarkers Prev ; 20(9 ) ; 1960–9 . © 2011 AACR Background : Most women with cervical cancer have not participated in Pap-smear screening .  Self-sampling of vaginal fluid in combination with high-risk HPV testing may be a method to increase the attendance rate . Methods : A total of 4060 women , 39–60 years old , who had not attended the organised Pap-smear screening for 6 years or more were r and omised into two equal groups . A study group was offered to self- sample vaginal fluid ( Qvintip ) at home and /or recommended to attend the Pap-smear screening . The collected fluid after self-sampling was examined for the presence of high-risk HPV ( Hybrid Capture 2 method ) . Controls were only recommended to attend the Pap-smear screening . The end point was a histological identification of CIN2–3 . Results : The participation rate was 39 % ( 771 out of 2000 ) in the self-sampling group and 9 % ( 188 out of 2060 ) in the conventional cytology ( P<0.001 ) . The number of histological CIN2–3 alterations detected was 0.4 % ( 8 out of 2000 ) among women offered self-sampling of vaginal fluid and 0.07 % ( 3 out of 4060 ) in women offered Pap-smears . The odds ratio ( OR ) for offering self-sampling and HPV testing instead of Pap-smear screening for detection of CIN2–3 was OR=5.42 ( 95 % CI : 1.30–31.8 ) . Conclusion : Offering self-sampling of vaginal fluid followed by a high-risk HPV test was considerably more effective for detection of histological CIN2–3 lesions in comparison with offering Pap-test in a midwife reception in women not regularly attending organised screening Background : Around 65 % of women with cervical carcinoma in Sweden have not attended an organised screening . We therefore investigated the value of using self-sampling at home in combination with a test for high-risk human papilloma virus ( HPV ) to increase participation . Methods : A total of 2829 women 30–58 years old , who had not attended the organised screening for ⩾6 years , were recruited . They were offered self-sampling at home ( Qvintip ) and recommended to send the collected vaginal fluid to a laboratory for analysis of the presence of high-risk HPV ( Hybrid Capture 2 method ) . Results : A total of 39.1 % of the women accepted home sampling . These women disclosed a relatively high prevalence of high-risk HPV , which decreased with age , from 11.1 % in women 30–39 years old to 2.9 % in women ⩾50 years . Follow-up disclosed histological cervical intraepithelial neoplasm ( CIN ) 2–3 lesions in 43.2 % of the women with a persistent HPV infection , corresponding to 2.0 % of the total number of participating women . The sensitivity of a single smear to detect the histological CIN 2–3 lesions were only 52.6 % , even if all abnormal smears ( atypical squamous cells of unknown significance (ASCUS)–CIN 3 ) ) were included . Conclusion : The use of self-sampling at home in combination with testing for high-risk HPV increases the participation rate of the organised screening and detects almost twice as many women with pre-malignant cell alterations ( CIN 2–3 ) in comparison those with a single cytological smear O 
    Output:
    
: HPV self-collected testing significantly improved the participation of women who did not routinely attend cervical cancer screening programs .
: L’autotest du  VPH  améliorait significativement la participation des femmes qui n’avaient pas systématiquement recours aux programmes de dépistage du cancer du col utérin .
De nouvelles approches de prestation de l’autotest du VPH devraient être envisagées à mesure que l’intégration du test du VPH en tant qu’outil de dépistage primaire se généralise