Feasibility of sending a direct send HPV self-sampling kit to long-term non-attenders in an organized cervical screening program. (January 2022)

• Record Type: Journal Article
• Authors: Sahlgren, Hanna; Sparén, Pär; Elfgren, Kristina; Miriam Elfström, K.
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 268(2022)
• Page Start: 68
• Page End: 73
• Publication Date: 2022-01
• Subjects: HPV Human papillomavirus -- LSIL Low grade squamous intraepithelial lesion -- HSIL High grade squamous intraepithelial lesion -- CIN Cervical Intraepithelial Neoplasia; HPV -- HPV self sampling -- Cervical cancer -- Cervical cancer screening; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2021.11.430
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Introduction: Non-participation in screening is a main risk factor for cervical cancer. Human-papillomavirus (HPV) self-sampling may be an alternative to repeated invitations for non-attenders. Several studies have concluded that participation among non-attenders increases significantly when offering self-sampling kits for HPV. However, participation rates are highly variable between settings, and therefore pilots to determine optimal implementation strategy have been recommended before routine roll out. Materials and Methods: All women who had not participated in the organized screening program for at least 10 years aged 33–62 in one Swedish county were identified through screening registers. HPV self-sampling kits were sent to all eligible women. Participation was defined as returning a self-sample kit or attending routine screening within 6 months. Women who did not submit the kit within 8 weeks were randomized to receive a written reminder. HPV-positive women were referred directly to colposcopy without prior triage. Biopsies for histopathologic confirmation were used as gold standard. Results: Among eligible women, 150/741 (20.2%) returned the self-sample kit or attended routine screening. A randomized written reminder was sent out to 319/591 non-responders and another 11 women returned the kit. In total, 23/147 (16.3%) of returned kits were HPV positive. Out of the 23 HPV-positive women, 17 (74%) attended colposcopy; 10/17 (59%) had a histopathological high-grade squamous intraepithelial lesions (HSIL) or cervical cancer. The most common HPV type was HPV 52, and 2 out of 3 women with HPV 16 had a histopathologically confirmed cancer. Conclusion: The direct send kit strategy and referral of all HPV-positive women to colposcopy without prior triage appears to be feasible if resources are available and should be prioritized given the high prevalence of HSIL lesions and cancer among non-attenders. A written reminder might further increase attendance.