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

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    18 Citations (Scopus)


    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.

    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.

    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).

    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
    Issue number1
    Early online date14 Nov 2017
    Publication statusPublished - 9 Jan 2018


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


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