Efficacy of offering a self-sampling device by the GP to reach women underscreened in the routine cervical cancer screening programme compared to sending reminder letters by the screening organization (ESSAG trial)

Project Details


Cervical cancer is highly preventable through accurate screening, but there is an important social inequity in both the uptake of cervical screening as well as in the incidence and mortality of cervical cancer. Especially women over 50 years old, living in poverty or not having the Belgian nationality are less screened and show higher incidence of cervical cancer. Today, consistent evidence is available indicating that screening with an HPV test is more effective to prevent cervical cancer than a Pap smear. Also in Belgium, HPV-based screening will soon replace cytology-based screening. HPV testing with an appropriate validated assay on a vaginal sample taken by the woman herself is as accurate as on
a cervical clinician-taken sample. Offering self-sampling kits may provide opportunities to lift the barriers for
participation in screening. Sending self-sampling kits to the women’s home address has been shown in population trials in multiple countries (also in Flanders) to be more effective in generating a response than sending invitation or
reminder letters recommending to have a Pap smear taken by a gynaecologist or general practitioner. Systematic reviews showed an average pooled participation rate of approximately 20% among women who received by mail a self- sampling device versus about halve among women receiving the routine invitation. However, ranges of participation varied widely according to countries and settings. More recent findings indicate that the participation rate might be substantially higher if the self-sampling device is provided directly to the woman by a caregiver. However, the trials
demonstrating this were conducted in developing countries or just in a small Belgian trial conducted and therefore more
research is needed to verify whether these findings are reproducible at population scale in western countries.
The ESSAG trial aims to evaluate on a large scale the participation rate in two GP-based interventions and compare them to the currently existing intervention. ESSAG will enroll women who have not been screened during the last 6 years and have a global medical file at a given GP practice. The global medical file of participating GPs will be completed with screening status information from the cancer screening organisation. Three intervention arms will be set up (cluster-randomised trial).
StatusNot started
Effective start/end date1/09/2131/08/25


  • Self-sampling device
  • underscreened woman
  • cervical cancer
  • ESSAG trial

Flemish discipline codes

  • Other medical and health sciences not elsewhere classified