HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: cohort study

Abstract

Participants 28 073 women who had not responded to two invitations to the regular cervical screening programme: 27 792 women were assigned to the self sampling group and invited to submit a self collected cervicovaginal sample for HPV testing; 281 were assigned to the recall control group and received a second reinvitation for conventional cytology. Intervention Women with a positive result on the high risk HPV test on their self sample material were referred to their general practitioner. Women with abnormal results on cytology were referred for colposcopy. Women with normal results on cytology were re-evaluated after one year by cytology and high risk HPV testing and referred for colposcopy if either result was positive. Main outcome measures Attendance rate in both groups and yield of cervical intraepithelial neoplasia grade II/III or worse (≥CIN II/≥CIN III) in self sampling responders. Results The compliance rate in the self sampling group was significantly higher than in the control group (crude 26.6% v 16.4%, P<0.001; adjusted 27.5% v 16.6%, P<0.001). The number of detected ≥CIN II and ≥CIN III lesions in self sampling responders was 99 (1.3%) and 76 (1.0%), respectively. Self sampling responders who had not participated in the previous round of screening (43%) had increased relative risks of ≥CIN II (2.04, 95% confidence interval 1.27 to 3.28) and ≥CIN III (2.28, 1.31 to 3.96) compared with self sampling women who had been screened in the previous round (57%). ConclusionsOffering self sampling by sending a device for collecting cervicovaginal specimens for high risk HPV testing to women who did not attend regular screening is a feasible and effective method of increasing coverage in a screening programme. The response rate and the yield of high grade lesions support implementation of this method for such women. Trial registration ISRCTN45527158.

Human papillomavirus self-sampling for screening nonattenders: Opt-in pilot implementation with electronic communication platforms

“…The self‐taken sample can be returned for analysis directly to the laboratory using regular mail. In previous studies from screening programs with high screening coverage rates, such as the Netherlands and various Scandinavian countries, all nonattenders were mailed self‐sampling kits (“opt‐out” approach) 6, 7, 8, 9. This strategy, where 6–34% of nonattenders returned their self‐sampling kits for analysis,6, 10 leads to considerable waste of the distributed, but unused kits.…”

Methodological Issues in Sampling the Local Immune System of the Female Genital Tract in the Context of HIV Prevention Trials

“…Though clinician sampling has the advantage of being standardized, the development of new devices for self-collection is ongoing with an aim to improve participant acceptability as well as sample between clinic visits (samples can be dropped off, or returned by post to a centralized laboratory). 13,14 Examples of undiluted selfsampling methods include a vaginal cup, an aspirator or a swab. Lavages, with new self-sampling devices, have also been tested in clinical trial settings.…”

Increasing participation in cervical cancer screening: Telephone contact with long‐term non‐attendees in Sweden. Results from RACOMIP, a randomized controlled trial

“…Offering a HPV self-test has, in some studies, increased participation in the screening program. [17][18][19][20] In western Sweden, annual reminders and scheduled appointments have already been implemented and women in parts of the region can now re-book appointments on the Internet.…”