Abstract
BackgroundThe efficacy of cervical cancer screening programs is dependent on the participation rate. To increase participation among women not attending cervical cancer screening, self-collected samples for detection of high-risk human papillomavirus (hr-HPV) may be an option.The aims of this study were: to investigate the response rate to sending a self-collected vaginal sample for hr-HPV mRNA detection to long-term non-attendees; the compliance with follow-up among women positive for HPV in the self-sample; the prevalence of cervical dysplasia (high grade squamous intraepithelial lesion (HSIL), atypical squamous cells that cannot exclude HSIL (ASC-H) or adenocarcinoma in situ (AIS)) or cancer among the responders; as well as to explore reasons for not returning a self-sample.MethodsA vaginal self-sampling kit was sent to 6023 women aged 30–70 years who had not provided a cervical screening sample for ≥7 years in the Region of Skåne, Sweden in November and December 2017. The self-sample was analyzed by Aptima HPV mRNA assay (Hologic). All vaginal self-samples returned no later than May 31, 2018 were included in the study. Follow-up of the results was registered until January 31, 2019 with a follow-up time varying between eight to 14 months. Women positive for hr-HPV mRNA were invited for a follow-up examination. This examination consisted of a cervical sample for cytological analysis and renewed Aptima HPV mRNA testing. Two hundred thirty-five women who had not returned the self-sample were randomly selected for telephone interviews, in order to explore their reasons.ResultsThe response rate for the self-collected vaginal hr-HPV sample was 13.2% [(797/6023), 95% CI 12.4–14.1%] and 9.9% [(79/796), 95% CI 7.9–12.2%] were positive for hr-HPV mRNA. The prevalence of severe dysplasia or cancer in the whole group of responders was 1.3% [(10/796), 95% CI 0.6–2.3%], with a cervical cancer prevalence of 0.4% [(3/796), 95% CI 0.1–1.1%]. Only 27 women participated in the telephone interviews, no particular reason for not returning self-samples was observed.ConclusionsSelf-collected vaginal hr-HPV samples increased participation in the cervical cancer screening among long-term non-attendees. The prevalence of cervical cancer was almost seven times higher for long-term non-attendees than in the organized screening population.
Highlights
The efficacy of cervical cancer screening programs is dependent on the participation rate
With the implementation of screening methods for detection of high-risk human papillomavirus, the major causal factor of cervical dysplasia and invasive cancer [8], a vaginal hr-Human papillomavirus (HPV) self-sampling method performed by the woman herself at home has become an option
High risk human papillomavirus (Hr-HPV) mRNA was detected among 9.9% [(79/796), 95% confidence intervals (CI) 7.9– 12.2%] of the self-samples
Summary
The efficacy of cervical cancer screening programs is dependent on the participation rate. To increase participation among women not attending cervical cancer screening, self-collected samples for detection of highrisk human papillomavirus (hr-HPV) may be an option. With the implementation of screening methods for detection of high-risk human papillomavirus (hr-HPV), the major causal factor of cervical dysplasia and invasive cancer [8], a vaginal hr-HPV self-sampling method performed by the woman herself at home has become an option. These selfcollected samples could be one way to reach screening non-attendees and are recommended in the Swedish national guidelines [9]. On August 29, 2019, only seven out of 21 regions in Sweden had implemented self-collected sampling of screening non-attendees, making it important to evaluate the results of the few regions that use self-collected HPV samples [10]
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