Cancer detection using human papillomavirus self‐sampling targeting long‐term non‐attenders in an organized cervical screening program

Abstract

Self‐sampling for human papillomavirus (HPV) is an established strategy to increase participation in cervical screening. We previously reported a randomized trial targeting women who had not attended screening after >10 invitations, where sending of self‐sampling kits resulted in a 19% attendance and a positive predictive value (PPV) for high grade lesions (HSIL+) of 40%, despite no triaging after the HPV test. Because of the striking results, the intervention was extended to all women resident in Stockholm County, Sweden, in the years 2019/20, who had not attended screening >10 years ( N  = 42,409). Participation was 35.6% and 11.6% of the participating women were HPV‐positive. Among these, there were 43 cases of invasive cervical cancer and 319 cases of high‐grade lesions. The PPV was particularly high for HPV16/18 positive women (12% for invasive cancer and 59% for HSIL). In summary, participation with HPV self‐sampling among long‐term non‐attenders in the real‐life program was considerably higher than in the research setting and the high yield of HSIL+ implied high effectiveness.