Human papillomavirus testing on self‐sampled cervicovaginal brushes: An effective alternative to protect nonresponders in cervical screening programs

Women not attending cervical screening programs are at increased risk of cervical cancer. We investigated in these nonresponders to what extent offering self‐sampling devices for cervicovaginal brushes for high‐risk human papillomavirus (hrHPV) testing would induce participation and, if so, what the...

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Published in:International journal of cancer 2007-04, Vol.120 (7), p.1505-1510
Main Authors: Bais, Aagje G., van Kemenade, Folkert J., Berkhof, Johannes, Verheijen, René H.M., Snijders, Peter J.F., Voorhorst, Feja, Babović, Milena, van Ballegooijen, Marjolein, Helmerhorst, Theo J.M., Meijer, Chris J.L.M.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Carcinoma in Situ - epidemiology
Carcinoma in Situ - genetics
Carcinoma in Situ - virology
cervical cytology
Cervical Intraepithelial Neoplasia - epidemiology
Cervical Intraepithelial Neoplasia - genetics
Cervical Intraepithelial Neoplasia - virology
cervical screening program
Cervix Uteri - pathology
Cervix Uteri - virology
Female
Genital system. Mammary gland
Human papillomavirus
Humans
Investigative techniques, diagnostic techniques (general aspects)
Mass Screening
Medical sciences
Middle Aged
Neoplasm Invasiveness - genetics
nonresponders
Papillomaviridae - genetics
Papillomaviridae - isolation & purification
Papillomavirus Infections - diagnosis
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
self‐sampling
Sensitivity and Specificity
Specimen Handling - instrumentation
Specimen Handling - methods
Tumors
Uterine Cervical Neoplasms - epidemiology
Uterine Cervical Neoplasms - genetics
Uterine Cervical Neoplasms - virology
Vaginal Smears
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Summary:Women not attending cervical screening programs are at increased risk of cervical cancer. We investigated in these nonresponders to what extent offering self‐sampling devices for cervicovaginal brushes for high‐risk human papillomavirus (hrHPV) testing would induce participation and, if so, what the yield of precursor (i.e. CIN2 or worse) lesions following self‐sampling would be. In addition, we assessed screening history of participants and costs per detected high‐grade CIN2 or worse (“CIN2+”) lesion in comparison to the regular program in the Netherlands. Nonresponders received a device for hrHPV testing (self‐sampling group, n = 2,546) or an extra recall for conventional cytology (control group, n = 284). The percentage of self‐sampling responders were compared with responders in the recall group. hrHPV positive self‐sampling responders were invited for cytology and colposcopy. CIN2+ yield and costs per detected CIN2+ were evaluated. Active response was higher in the self‐sampling than in the control group (34.2 vs. 17.6%; p < 0.001). hrHPV positive self‐sampling responders were less likely to have a prior screening history than screening participants (p < 0.001), indicating that they are regular nonresponders. hrHPV prevalence was similar (8.0 vs. 6.8%; p = 0.11), but CIN2+ yield was higher in self‐sampling responders compared to screening participants (1.67 vs. 0.97%; OR = 2.93, 95% CI 1.48–5.80; p = 0.0013). Costs per CIN2+ lesion detected via self‐sampling were in the same range as those calculated for conventional cytological screening (€8,836 vs. €7,599). Offering self‐sampling for hrHPV testing in nonresponders is an attractive adjunct to effectively increase population coverage of screening without the adverse effect of markedly increased costs per detected CIN2+ lesion. © 2006 Wiley‐Liss, Inc.
ISSN:0020-7136
1097-0215
DOI:10.1002/ijc.22484