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Cervical cancer screening improvements with self-sampling during the COVID-19 pandemic
Miriam Elfström1,2, Penelope Grace Gray1, Joakim Dillner1
1Center for Cervical Cancer Elimination, F46, Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital and Division of Cervical Cancer Elimination, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Background:
At the onset of the COVID-19 pandemic cervical screening in the capital region of Sweden was canceled for several months. A series of measures to preserve and improve the cervical screening under the circumstances were instituted, including a switch to screening with HPV self-sampling to enable screening in compliance with social distancing recommendations.
Methods:
We describe the major changes implemented, which were (1) nationwide implementation of HPV screening, (2) switch to primary self-sampling instead of clinician sampling, (3) implementation of HPV screening in all screening ages, and (4) combined HPV vaccination and HPV screening in the cervical screening program.
Results:
A temporary government regulation allowed primary self-sampling with HPV screening in all ages. In the Stockholm region, 330,000 self-sampling kits were sent to the home address of screening-eligible women, instead of an invitation to clinician sampling. An increase in organized population test coverage was seen (from 54% to 60% in just 1 year). In addition, a national campaign for faster elimination of cervical cancer with concomitant screening and vaccination for women in ages 23-28 was launched.
Conclusions:
The COVID-19 pandemic necessitated major changes in the cervical cancer preventive strategies, where it can already be concluded that the strategy with organized primary self-sampling for HPV has resulted in a major improvement of population test coverage.
Funding:
Funded by the Swedish Association of Local Authorities and Regions, the Swedish Cancer Society, the European Union's Horizon 2020 Research and Innovation Program, the Swedish government, and the Stockholm county.
