Abstract
Background:Self-sampling for human papillomavirus (HPV) offered to women who do not participate in cervical cancer screening is an increasingly popular method to increase screening coverage. The rationale behind self-sampling is that unscreened women harbour a high proportion of undetected precancer lesions. Here, we compare the cervical intraepithelial neoplasia grade 2 or worse (⩾CIN2) detection rate between non-attenders who participated in self-sampling and women attending routine screening.Methods:A total of 23 632 women who were qualified as non-attenders in the Copenhagen Region were invited for HPV-based self-sampling. Of these, 4824 women returned a self-sample, and HPV-positive women were referred for cytology and HPV co-testing as follow-up. The entire cohort and a reference cohort (3347 routinely screened women) were followed for histopathology confirmed ⩾CIN2. Odds ratio (OR) and the relative positive predictive value of ⩾CIN2 detection between the two populations were estimated.Results:Women participating in self-sampling had a higher ⩾CIN2 detection than women undergoing routine cytology-based screening (OR=1.83, 95% CI: 1.21–2.77) and a similar detection as routinely screened women tested with cytology and HPV testing (OR=1.03, 95% CI: 0.75–1.40). The positive predictive value for ⩾CIN2 was higher in screening non-attenders than in routinely HPV- and cytology-screened screened women (36.5% vs 25.6%, respectively).Conclusions:Self-sampling offered to non-attenders showed higher detection rates for ⩾CIN2 than routine cytology-based screening, and similar detection rates as HPV and cytology co-testing. This reinforces the importance of self-sampling for screening non-attenders in organised cervical cancer screening.
Highlights
Self-sampling for human papillomavirus (HPV) offered to women who do not participate in cervical cancer screening is an increasingly popular method to increase screening coverage
Women participating in self-sampling had a higher XCIN2 detection than women undergoing routine cytology-based screening and a similar detection as routinely screened women tested with cytology and HPV testing
The positive predictive value for XCIN2 was higher in screening non-attenders than in routinely HPV- and cytology-screened screened women (36.5% vs 25.6%, respectively)
Summary
A total of 23 632 women who were qualified as non-attenders in the Copenhagen Region were invited for HPV-based self-sampling. The women invited for self-sampling were sent a letter with information on cervical cancer screening and the association between HPV and cervical cancer; they could order a self-sampling brush from our laboratory and return it using a prestamped envelope. An additional 4291 women were not screened via self-sampling, but screened by a GP after receiving the self-sampling invitation letter. Note that these numbers differ from those reported previously (Lam et al, 2017), owing to a longer follow-up (November 2016 instead of December 2015). Upon a positive HPV self-sample (i.e., if any of the three HPV assays gave a positive test result), women were referred to a GP-taken cytology follow-up sample. The women included in CSi were followed for 18 months (until November 2016) after the last invitations were sent
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