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Chromogenic In Situ Hybridization as a Tool for HPV-Related Head and Neck Cancer Diagnosis
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Implementation of HPV-based Cervical Cancer Screening Combined with Self-sampling Using a Midwifery Network Across

Theodoros Agorastos1, Kimon Chatzistamatiou2, Athena Tsertanidou1

  • 1Fourth Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

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Summary

Self-sampling for human papillomavirus (HPV) testing offers a viable alternative for cervical cancer screening, especially for non-attenders. The GRECOSELF study demonstrated its effectiveness in remote Greek areas, utilizing midwives for sample collection and HPV-DNA testing.

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Area of Science:

  • Oncology
  • Public Health
  • Gynecology

Background:

  • Cervical cancer screening non-attenders, particularly in remote areas, pose a challenge for secondary prevention.
  • Human papillomavirus (HPV) testing via self-sampling presents a practical alternative to traditional physician-collected samples.
  • Implementing HPV-DNA testing through a midwifery network can improve screening accessibility.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of implementing HPV-DNA testing with self-sampling for cervical cancer screening in Greece.
  • To assess the prevalence of high-risk HPV (hrHPV) and high-grade cervical/vaginal disease in women from remote areas.
  • To suggest a model for nationwide HPV-DNA testing utilizing a midwifery network.

Main Methods:

  • A nationwide observational cross-sectional study (GRECOSELF) involving women in remote Greek areas.
  • Midwives provided self-collection kits (dry swabs) for cervicovaginal sampling and administered questionnaires.
  • Samples were tested for hrHPV using the Cobas HPV test; positive cases were referred for colposcopy and potential treatment.

Main Results:

  • 13,111 women were recruited; 12,787 provided valid data. The overall hrHPV prevalence was 8.3%, with high-grade cervical/vaginal disease or cancer prevalence at 0.6%.
  • HrHPV positivity decreased with age, from 20.7% in women aged 25-29 to 5.1% in women aged 50-60.
  • Compliance to colposcopy referral varied by age group, ranging from 68.6% to 76.3%. The positive predictive value for hrHPV testing ranged from 5.0% to 11.6%.

Conclusions:

  • HPV-DNA testing with self-collected cervicovaginal samples via dry swabs, facilitated by midwives, is a promising strategy for cervical cancer secondary prevention in remote Greek populations.
  • The study highlights the potential of leveraging existing healthcare networks, like midwifery services, to enhance screening accessibility and coverage.
  • Age-specific hrHPV prevalence data can inform targeted screening strategies and resource allocation for cervical cancer prevention programs.