Abstract
Self-sampling for human papillomavirus (HPV) testing is an alternative to physician sampling particularly for cervical cancer screening nonattenders. The GRECOSELF study is a nationwide observational cross-sectional study aiming to suggest a way to implement HPV-DNA testing in conjunction with self-sampling for cervical cancer screening in Greece, utilizing a midwifery network. Women residing in remote areas of Greece were approached by midwives, of a nationwide network, and were provided with a self-collection kit (dry swab) for cervicovaginal sampling and asked to answer a questionnaire about their cervical cancer screening history. Each sample was tested for high-risk (hr) HPV with the Cobas HPV test. HrHPV-Positive women were referred to undergo colposcopy and, if needed, treatment according to colposcopy/biopsy results. Between May 2016 and November 2018, 13,111 women were recruited. Of these, 12,787 women gave valid answers in the study questionnaire and had valid HPV-DNA results; hrHPV prevalence was 8.3%; high-grade cervical/vaginal disease or cancer prevalence was 0.6%. HrHPV positivity rate decreased with age from 20.7% for women aged 25-29 years to 5.1% for women aged 50-60 years. Positive predictive value for hrHPV testing and for HPV16/18 genotyping ranged from 5.0% to 11.6% and from 11.8% to 27.0%, respectively, in different age groups. Compliance to colposcopy referral rate ranged from 68.6% (for women 25-29) to 76.3% (for women 40-49). For women residing in remote areas of Greece, the detection of hrHPV DNA with the Cobas HPV test, on self-collected cervicovaginal samples using dry cotton swabs, which are provided by visiting midwives, is a promising method for cervical cancer secondary prevention.
Highlights
Cervical infection by high-risk human papillomaviruses is considered to be the primary cause for the development of cervical cancer [1]
We launched GRECOSELF, the GREek CObas SELF-sampling study, a multicenter observational cross-sectional study aiming to suggest a way to implement human papillomavirus (HPV)-DNA testing in conjunction with self-sampling, for women residing in remote areas of Greece, including mountainous villages and islands, utilizing a midwifery network
The main objective of the GRECOSELF study was to explore the implementation of self-sampling combined with high-risk human papillomaviruses (hrHPV) DNA testing in Greece, utilizing a nationwide midwifery network to approach women residing in remote rural areas of the country who do not have regular access to cervical cancer screening
Summary
Cervical infection by high-risk human papillomaviruses (hrHPV) is considered to be the primary cause for the development of cervical cancer [1]. In Greece, effective secondary cervical cancer prevention remains an unmet need, because cervical cancer screening is opportunistic rather than organized, resulting in only a third of the female population reporting being screened on a regular basis [7]. With this in mind, we launched GRECOSELF, the GREek CObas SELF-sampling study, a multicenter observational cross-sectional study aiming to suggest a way to implement HPV-DNA testing in conjunction with self-sampling, for women residing in remote areas of Greece, including mountainous villages and islands, utilizing a midwifery network
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