Cancer detection using human papillomavirus self-sampling targeting long-term non-attenders in an organized cervical...

Area of Science:

• Oncology
• Public Health
• Gynecology

Background:

• Cervical screening participation remains suboptimal, particularly among long-term non-attenders.
• Human papillomavirus (HPV) self-sampling is a proven strategy to improve screening uptake.
• Previous trials showed promise, but real-world effectiveness needed evaluation.

Purpose of the Study:

• To assess the effectiveness of HPV self-sampling in a large-scale, real-world program targeting long-term non-attenders for cervical screening.
• To evaluate participation rates and the yield of high-grade squamous intraepithelial lesions (HSIL+) and invasive cervical cancer.

Main Methods:

• An intervention offering HPV self-sampling kits was extended to all women in Stockholm County, Sweden, with no screening attendance for over 10 years (N=42,409).
• Participation rates, HPV positivity, and the positive predictive value (PPV) for HSIL+ and invasive cancer were analyzed.
• Data from a prior randomized trial served as a comparison for the research setting.

Main Results:

• Overall participation reached 35.6%, substantially higher than the 19% in the prior randomized trial.
• HPV positivity was observed in 11.6% of participants.
• The program detected 43 cases of invasive cervical cancer and 319 cases of HSIL+.
• The PPV for HSIL+ was high, especially in HPV16/18 positive women (59% for HSIL+, 12% for invasive cancer).

Conclusions:

• HPV self-sampling is highly effective in engaging long-term non-attenders in cervical screening in a real-world setting.
• The intervention demonstrated a high yield of significant cervical abnormalities, including invasive cancers.
• This strategy represents a successful public health approach to improve cervical cancer prevention coverage.