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High-grade cervical intraepithelial neoplasia in human papillomavirus self-sampling of screening non-attenders.
Br J Cancer. 2018 01; 118(1):138-144.BJ

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.

Authors+Show Affiliations

Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark.Department of Laboratory Medicine, Karolinska Institutet, Stockholm 14186, Sweden.Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark.Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark.Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark.Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark.Department of Public Health, University of Copenhagen, Copenhagen 1014, Denmark.Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen 2100, Denmark.Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen 2100, Denmark. Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.Department of Laboratory Medicine, Karolinska Institutet, Stockholm 14186, Sweden. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 14186, Sweden.Department of Pathology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark. Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Copenhagen, Denmark.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29136403

Citation

Lam, J U H., et al. "High-grade Cervical Intraepithelial Neoplasia in Human Papillomavirus Self-sampling of Screening Non-attenders." British Journal of Cancer, vol. 118, no. 1, 2018, pp. 138-144.
Lam JUH, Elfström KM, Ejegod DM, et al. High-grade cervical intraepithelial neoplasia in human papillomavirus self-sampling of screening non-attenders. Br J Cancer. 2018;118(1):138-144.
Lam, J. U. H., Elfström, K. M., Ejegod, D. M., Pedersen, H., Rygaard, C., Rebolj, M., Lynge, E., Juul, K. E., Kjær, S. K., Dillner, J., & Bonde, J. (2018). High-grade cervical intraepithelial neoplasia in human papillomavirus self-sampling of screening non-attenders. British Journal of Cancer, 118(1), 138-144. https://doi.org/10.1038/bjc.2017.371
Lam JUH, et al. High-grade Cervical Intraepithelial Neoplasia in Human Papillomavirus Self-sampling of Screening Non-attenders. Br J Cancer. 2018;118(1):138-144. PubMed PMID: 29136403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-grade cervical intraepithelial neoplasia in human papillomavirus self-sampling of screening non-attenders. AU - Lam,J U H, AU - Elfström,K M, AU - Ejegod,D M, AU - Pedersen,H, AU - Rygaard,C, AU - Rebolj,M, AU - Lynge,E, AU - Juul,K E, AU - Kjær,S K, AU - Dillner,J, AU - Bonde,J, Y1 - 2017/11/14/ PY - 2017/04/10/received PY - 2017/09/15/revised PY - 2017/09/26/accepted PY - 2017/11/15/pubmed PY - 2019/1/3/medline PY - 2017/11/15/entrez SP - 138 EP - 144 JF - British journal of cancer JO - Br. J. Cancer VL - 118 IS - 1 N2 - 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. SN - 1532-1827 UR - https://www.unboundmedicine.com/medline/citation/29136403/High_grade_cervical_intraepithelial_neoplasia_in_human_papillomavirus_self_sampling_of_screening_non_attenders_ L2 - http://dx.doi.org/10.1038/bjc.2017.371 DB - PRIME DP - Unbound Medicine ER -