Avalon Sundqvist

Self‐collected vaginal HPV samples for long‐term non‐attendees in the Swedish organized cervical cancer screening program

AbstractIntroductionMost cervical cancer cases in Sweden are diagnosed among women who have failed to attend screening. The objective of this study was to analyze the effectiveness of offering vaginal HPV (human papillomavirus) self‐samples to long‐term non‐attendees as a routine in this screening program, in which non‐attendees had already been the targets of several interventions.Material and MethodsRegister data from the organized cervical screening program were used in this population‐based study. From January 2016 to December 2019, 33 881 high‐risk (hr‐) HPV self‐sample kits were sent to the homes of long‐term screening non‐attendees (≥7 years without a registered screening test), aged between 29 and 64 years, in Region Västra Götaland, Sweden. All samples returned to the laboratory were analyzed with the Cobas HPV DNA assay (Roche) for HPV16, HPV18, and for 12 other hr‐HPV types. HPV‐positive women were referred for colposcopy. Compliance and results of follow‐up were assessed 12 months after HPV analysis. Descriptive statistics, trend analysis, and risk ratios were used to compare outcomes across groups.ResultsThe median age of invited women was 49 years; 35% had not been screened before. The response rate was 19.4% (6582/33881). The HPV prevalence was 12.0% (788/6582), and 80.2% of HPV‐positive women attended follow‐up. Women with no previous cervical sample had a lower response rate: 15.7% (RR (Risk ratio) 0.73 (95% CI (Confidence interval) 0.70–0.77)). They also had lower attendance in follow‐up when HPV‐positive (71.6% RR 0.86 (CI 0.78–0.94)), compared with women who had previous samples. The proportions of high‐grade histopathology (HSIL+) among followed‐up women were 31.3% for HPV16, 15.2% for HPV18, and 8.8% for HPVnon‐16/18. Nine cervical cancer cases were found among 6582 women, corresponding to a rate of 137 cases per 100,000 women.ConclusionsVaginal HPV self‐samples increased cervical screening attendance by almost one‐fifth among non‐attendees who had previously resisted several invitations and interventions. Biopsied women positive for HPV16 or HPV18 had a high prevalence of HSIL or cervical cancer, which strongly supports direct referral to colposcopy. Long‐term non‐attendees have an exceptionally high risk of cervical cancer and should receive special attention.

Vulvar cancer incidence and net survival in Sweden 1960 to 2019: A population‐based national study

AbstractIntroductionVulvar cancer is a rare gynecological cancer affecting mostly older women. The aim of this population‐based study was to investigate the incidence and net survival of vulvar cancer in Swedish women from 1960 to 2019.Material and methodsData were retrieved from the mandatory Swedish Cancer Registry consisting of all women diagnosed with vulvar cancer between 1960 and 2019. Only women with a morphologically verified diagnosis of vulvar cancer were included. The individuals were then further matched with the Swedish Death Registry up until May 31, 2020.ResultsIn total, 8499 women were included with the following morphologies: squamous cell carcinoma 7250 (85.8%), malignant melanoma 539 (6.4%), adenocarcinoma 401 (4.8%) and other: 259 (3.1%). More than 50% of vulvar cancer cases occurred in women aged between 65 and 84 years of age. The 5‐year age‐standardized net survival increased from 53.0% (95% confidence interval [CI] 48.9–57.5) in 1960 to 72.1% (95% CI 68.8–75.5) in 2019. The proportion of adenocarcinoma among all cases increased from 2.0% to 8.7% between the 1960s and 2010s and an increase in age‐standardized 5‐year net survival was found for adenocarcinoma.ConclusionsThe age‐standardized incidence of vulvar cancer cases in Sweden was stable between 1960 and 2019. During the study period, an increase in adenocarcinoma and a decrease in malignant melanoma cases was found. Five‐year net survival increased by 20 percent units during the study period. For squamous cell carcinoma, an increased age‐specific 5‐year net survival was observed for all age groups, apart for women aged ≥85.

Cervical neoplasia in relation to socioeconomic and demographic factors – a nationwide cohort study (2002–2018)

AbstractIntroductionCervical cancer is a major cause of mortality and morbidity. We aimed to estimate the association between sociodemographic factors and cervical neoplasia.Material and methodsIn this Swedish nationwide open cohort study, 4 120 557 women aged ≥15 years at baseline were included between January 1, 2002 and December 31, 2018. The two outcomes were cervical cancer and carcinoma in situ identified in the Swedish Cancer Register. Sociodemographic factors (age, education level, family income level, region of residency, country of origin) were the main predictors. Incidence rates per 10 000 person‐years were calculated. Cox regression was used to estimate hazard ratios. Sensitivity analyses were conducted, including parity, urogenital infections, alcohol‐ and drug‐use disorders, and chronic obstructive pulmonary disease (used as a proxy for tobacco abuse).ResultsIn 38.9 million person‐years of follow‐up, 5781 (incidence rate: 1.5, 95% confidence interval [CI] 1.4–1.5) and 62 249 (incidence rate 16.9, 95% CI 15.9–16.1) women were diagnosed with cervical cancer and carcinoma in situ, respectively. Women from Eastern Europe had a hazard ratio of 1.18 (95% CI 1.05–1.33) for cervical cancer compared with Swedish‐born women, while women from non‐Western regions were inversely associated with cervical cancer and carcinoma in situ. Women with a low education level had a hazard ratio of 1.37 (95% CI 1.29–1.45) for cervical cancer compared with women with a high education level.ConclusionsWomen from the Middle East and Africa living in Sweden seem to suffer less from cervical neoplasia, whereas women with low education and women from Eastern Europe seem to suffer more from cervical cancer.

Time Trends for Incidence and Net Survival of Cervical Cancer in Sweden 1960–2014—A Nationwide Population-Based Study

Abstract Background: The aim was to investigate time trends for incidence and long-term net survival in the morphologic subtypes and stages of cervical cancer in Sweden during the period 1960 to 2014. Methods: Women with invasive cervical cancer were identified through the Swedish Cancer Registry. Incidence and net survival were calculated according to morphology, age at diagnosis, and FIGO stage at diagnosis. Results: In total, 29,579 cases of invasive cervical cancer between 1960 and 2014 were included. The age-standardized incidence for squamous cell carcinoma (SCC) decreased until 2000; thereafter, the incidence rate stagnated, and a small increase was found in 2014. The incidence of adenocarcinoma continuously increased. The age-standardized 5-year net survival increased. However, decreasing net survival with increasing age was found. A higher stage at diagnosis showed a worse net survival. SCC and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. Conclusions: Age-standardized 5-year net survival improved between 1960 and 2014. A positive trend for short- and long-term net survival was seen for women ages 18 to 64 years but long-term net survival for women ≥75 years decreased. In this study, age and FIGO stage at diagnosis were found to be important prognostic factors in determining net survival. The morphologies, SCC, and adenocarcinoma did not statistically differ as regards net survival in the last years of the study. Impact: This study demonstrates longitudinal data on cervical cancer in Sweden for over 50 years with sub analyses on morphology, age, and stage at diagnosis.