Self-sampling of the vaginal fluid at home combined with high-risk HPV testing

Abstract

Background:Around 65% of women with cervical carcinoma in Sweden have not attended an organised screening. We therefore investigated the value of using self-sampling at home in combination with a test for high-risk human papilloma virus (HPV) to increase participation.Methods:A total of 2829 women 30–58 years old, who had not attended the organised screening for ⩾6 years, were recruited. They were offered self-sampling at home (Qvintip) and recommended to send the collected vaginal fluid to a laboratory for analysis of the presence of high-risk HPV (Hybrid Capture 2 method).Results:A total of 39.1% of the women accepted home sampling. These women disclosed a relatively high prevalence of high-risk HPV, which decreased with age, from 11.1% in women 30–39 years old to 2.9% in women ⩾50 years . Follow-up disclosed histological cervical intraepithelial neoplasm (CIN) 2–3 lesions in 43.2% of the women with a persistent HPV infection, corresponding to 2.0% of the total number of participating women. The sensitivity of a single smear to detect the histological CIN 2–3 lesions were only 52.6%, even if all abnormal smears (atypical squamous cells of unknown significance (ASCUS)–CIN 3)) were included.Conclusion:The use of self-sampling at home in combination with testing for high-risk HPV increases the participation rate of the organised screening and detects almost twice as many women with pre-malignant cell alterations (CIN 2–3) in comparison those with a single cytological smear.

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

“…Their screening history was determined from a cytology register, suggesting that these women had been screened before. The achieved participation rates, using the Qvintip device, were 39%12 and 31% 11. In the latter study, therefore, a similar participation rate was achieved as in our intermittently screened Group (28%).…”

“…Our choice for an opt‐in strategy was mainly based on considerations of cost of purchase and mailing of self‐sampling kits including the administration of reminders. Two Swedish opt‐in studies by Sanner et al 12. and Stenvall et al 11.…”

“…An alternative approach is to have nonattenders actively “opt in,” that is, order the self‐sampling kits if interested after receiving an invitation from the screening program. Only few studies11, 12, 13, 14, 15, 16 have used the opt‐in approach so far, with a reported return rate of 9–39%. A general concern is that by requiring additional effort from women to confirm their willingness to participate, this approach is vulnerable to low participation rates 13, 14…”

Consultation rates in cervical screening non-attenders: opportunities to increase screening uptake in GP primary care

“…[10][11][12] Selfsampling for high-risk human papillomavirus (HPV) types has the potential to overcome these; women can take their own test in private, at a time and place of their choosing. Several studies [13][14][15][16][17][18][19] have assessed the uptake of self-sampling for HPV testing in screening non-attenders. Approaches have included posting selfsampling kits directly to women 10,13,15,[19][20][21][22][23] writing to women to ask them to order kits, [15][16][17] and offering kits door-to-door.…”

“…Several studies [13][14][15][16][17][18][19] have assessed the uptake of self-sampling for HPV testing in screening non-attenders. Approaches have included posting selfsampling kits directly to women 10,13,15,[19][20][21][22][23] writing to women to ask them to order kits, [15][16][17] and offering kits door-to-door. 14 Response rates have ranged between 8.7% and 52.1%, and were highest in women who were offered kits in person (ie.…”