Factors associated with cytology triage attendance after a hrHPV-positive self-sample and age-related differences: The lifelines cohort

BackgroundSelf-sampling for high-risk human papillomavirus (hrHPV) testing has been introduced in cervical cancer screening programs to improve participation. In the Netherlands, women with an hrHPV-positive self-sample are required to visit their GP's office for cytology triage, as this cannot be performed on self-sampled material. Non-attendance at this step reduces screening effectiveness. This study examined whether sociodemographic and health-related behavioural factors commonly associated with screening participation are also associated with cytology triage attendance after an hrHPV-positive self-sample and whether these associations differ by age.MethodsWe conducted a study on the Lifelines cohort of participants in the Dutch cervical cancer screening program who used self-sampling between 2017 and 2024. The main outcome was cytology triage attendance within 6 months after an hrHPV-positive self-sample. Lifelines contains data on sociodemographic and behavioural factors including education, income, marital status, smoking, alcohol, diet, body mass index, physical activity, television viewing, sleep duration, lifetime use of hormonal contraception, parity, number of children and age at first childbirth. Logistic regression analyses were performed, including age-stratified models.ResultsAmong women with an hrHPV-positive self-sample, 10.2% did not attend cytology triage within 6 months. Most sociodemographic and lifestyle factors were not associated with cytology triage attendance, and no meaningful differences were observed between age groups. However, inadequate prior screening history was associated with lower odds of cytology triage attendance.ConclusionsThe lack of associations with lifestyle or sociodemographic factors suggest that program-level strategies such as how hrHPV test results are communicated, might be more effective in increasing triage participation than interventions targeting specific subgroups.