High-grade cervical intraepithelial neoplasia in human papillomavirus self-sampling of screening non-attenders

J. U. H. Lam, K. M. Elfstrom, D. M. Ejegod, H. Pedersen, C. Rygaard, M. Rebolj, E. Lynge, K. E. Juul, S. K. Kjaer, J. Dillner, J. Bonde

    Research output: Contribution to journalArticlepeer-review

    18 Citations (Scopus)

    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.
    Original languageEnglish
    Pages (from-to)138-144
    JournalBritish Journal of Cancer
    Volume118
    Issue number1
    Early online date14 Nov 2017
    DOIs
    Publication statusPublished - 9 Jan 2018

    Keywords

    • HPV self-sampling
    • non-attenders
    • cervical cancer screening
    • HPV primary screening
    • cervical intraepithelial neoplasia
    • implementation
    • Denmark

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