Mail-in self-collection kits for human papillomavirus (HPV) were found to be effective at increasing cervical cancer screening rates compared with standard telephone reminders alone in a safety-net health-care setting, according to results from the PRESTIS trial published in JAMA Internal Medicine.
Women who received the kits were more than twice as likely to participate in screening compared with women who received a telephone reminder alone. Further modest increases in screenings were seen with the addition of patient navigation for these patients in underserved areas.
“Too many women, especially those who are uninsured, live in rural areas, or come from marginalized and underserved communities, aren’t getting screened for cervical cancer,” stated lead study author Jane Montealegre, PhD, Associate Professor of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center in Houston, Texas. “These results show that self-collection testing could be a solution to increasing access to screening and, in turn, reducing the burden of cervical cancer in the United States.”
Study Methods and Results
The first at-home screening tests for cervical cancer were approved by the U.S. Food and Drug Administration in May 2025.
“As self-collection tests become available in the United States, it’s vital that we gather data to guide how they are rolled out. We want to make sure that they become available in clinics and health centers that care for people who often have the hardest time accessing health care,” Dr. Montealegre said. “By removing barriers, we are hopeful that we can improve the uptake of evidence-based screening tests and make significant progress against this preventable disease.”
PRETIS was a real-world, parallel, single-blinded, randomized study that was conducted within a publicly funded safety-net health system in Houston, Texas. The study included 2,474 individuals who were eligible and overdue for cervical cancer screening, including some who had no prior screenings on record; all participants were enrolled in the study period between February 2020 and August 2023.
Ninety-four percent of the participants were from racial or ethnic minoritized populations, and 56.1% were covered by the country’s publicly funded financial assistance program.
The individuals were randomly assigned to receive one of three intervention approaches: a standard telephone reminder for clinic-based screening, a telephone reminder plus a mailed self-collection kit, or a reminder and a kit plus patient navigation support.
At 6 months, 17.4% of patients in the telephone reminder–only group had undergone cervical cancer screening compared with 41.1% of patients in the self-collection kit and telephone reminder group and 46.6% in the added patient navigation group.
Relative participation in cervical cancer screening was 2.36 times higher (95% confidence interval [CI] = 1.99–2.80) for the self-collection group and 2.68 times higher (95% CI = 2.27–3.16) for the patient navigation group compared with the telephone reminder–only group.
Additionally, over 80% of the women in both self-collection groups returned their kits.
The researchers will next study how the self-collection tests can be integrated into different primary care settings.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
