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Comparison between professional sampling and self-sampling for HPV-based cervical cancer screening among postmenopausal women
Örebro University, School of Health Sciences. Department of Women’s Health.ORCID iD: 0000-0002-1458-1542
Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
Örebro University, School of Health Sciences. Department of Laboratory Medicine.ORCID iD: 0000-0001-9992-266X
Örebro University, School of Medical Sciences. Department of Laboratory Medicine.ORCID iD: 0000-0001-6881-237X
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2018 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 142, no 3, p. 359-364Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate whether self-sampling is as reliable as professional sampling for HPV testing and genotype detection among postmenopausal women.

METHODS: In the present prospective cross-sectional study, women in Örebro County, Sweden, who had high-risk HPV (hrHPV) and normal cytology results in exit screening tests conducted in between January 1, 2012, and December 31, 2014, were invited to follow-up screenings between February 24, 2015 and May 15, 2015, that included professional sampling and self-sampling. HPV genotypes were identified by a DNA-based assay that could detect 35 HPV genotypes. Findings between the different sampling methods were compared.

RESULTS: Of 143 women who participated, 119 returned a self-sample. Completely concordant results were observed in 67 of these samples when both hrHPV and low-risk HPV genotypes were analyzed. Overall, 99 (83.2%) women had the same clinically relevant finding from both sampling methods. Twenty women had discordant hrHPV results (hrHPV detected in 10 self-samples vs 10 professionally collected samples; Cohen κ 0.66, 95% confidence interval 0.53-0.80). There was no significant difference between the two sampling methods for clinically significant infections (P>0.99) or extended genotyping (P=0.827).

CONCLUSION: Postmenopausal women could be offered self-sampling devices to increase screening-program coverage while maintaining test quality.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018. Vol. 142, no 3, p. 359-364
Keywords [en]
Cervical cancer, HPV, Postmenopausal women, Professional sampling, Screening, Self-sample
National Category
Cancer and Oncology Gynaecology, Obstetrics and Reproductive Medicine
Identifiers
URN: urn:nbn:se:oru:diva-67134DOI: 10.1002/ijgo.12538ISI: 000440652000017PubMedID: 29856071Scopus ID: 2-s2.0-85051073715OAI: oai:DiVA.org:oru-67134DiVA, id: diva2:1213223
Note

Funding Agencies:

Region Örebro County Research Committee  

Örebro University Hospital Research Foundation  

BBMRI.se

Available from: 2018-06-04 Created: 2018-06-04 Last updated: 2025-02-11Bibliographically approved
In thesis
1. Cervical screening with primary HPV: from research to clinical effectiveness
Open this publication in new window or tab >>Cervical screening with primary HPV: from research to clinical effectiveness
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Organized cervical screening has greatly reduced the incidence of cervical cancer where implemented. Human papilloma virus (HPV) is the cause of cervical cancer, and in later years, convincing evidence has led to cervical screening with HPV as the primary method being implemented around the world. The overall aim of this thesis is to improve cervical screening, with focus on HPV screening.

Papers I–III were performed with focus on postmenopausal women. Women aged, 55–59 years, excluded from the screening with a normal cytology cervical sample were found to have a high-risk HPV (hrHPV) prevalence of 5.5% in paper II. In a follow-up sample, 56% (71/126) had a persistent infection with the same genotype. Nineteen per cent of the women had dysplasia, where the majority of the high-grade squamous intraepithelial lesions (HSILs) were associated with HPV types other than HPV 16/18.

Women 55-59 has a lower attendance rate in the study region, and since self-sample has been proven to increase attendance, paper I was performed to compare self-sample and professionally collected samples in these postmenopausal women. The concordance between the sampling methods was 83%, and both tests detected all histological HSILs. When including a study with older women (aged 70 years) in paper III, 23% of histological HSILs were found in hrHPV-positive women.

Paper IV is a scientific evaluation of an implemented HPV-based screening programme, comparing clinical effectiveness and cost with cytology screening. More HSIL+ were detected in the new programme but at a higher cost than the old cytology-based programme. The screening visits for sampling accounted for two thirds of the costs.

Altogether, the results indicate the importance of having a negative HPVtest before exiting screening. Data also present the necessity to find biomarkers that are more specific than cytology and HPV 16/18 for triaging women with hrHPV to further follow-up, both among postmenopausal women and other age groups when screening with HPV, since many women without HSIL are coming for clinical follow-up and treatment. Extending the screening interval between hrHPV-negative tests as well as implementing selfsampling to a greater extent can be important changes, since two thirds of the costs in the programme come from screening visits for sampling.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2020. p. 85
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 209
Keywords
Cervical cancer, screening, human papillomavirus (HPV), HPV prevalence, HPV genotypes, precancerous lesion, HSIL, self-sampling, postmenopausal women, health economy
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-80231 (URN)978-91-7529-331-8 (ISBN)
Public defence
2020-05-15, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-02-27 Created: 2020-02-27 Last updated: 2021-11-19Bibliographically approved

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Bergengren, LovisaKaliff, MalinLillsunde-Larsson, GabriellaKarlsson, MatsHelenius, Gisela

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