Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 119, Issue 2, Pages 245-248Publisher
WILEY
DOI: 10.1111/j.1471-0528.2011.03147.x
Keywords
Cervix; cytology; human papillomavirus test; screening; self-sampling at home
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Funding
- County Council of Uppsala
- Medical Faculty of Uppsala University
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Objectives To study the value of self-sampling of vaginal fluid at home in combination with high-risk human papillomavirus (HPV)testing in a cohort of older women not attending Papanicolaou (Pap) smear screening. Design Women (n = 3618), aged 50-65 years, who had not attended screening for at least 6 years were offered self-sampling of vaginal fluid at home (study cohort). The collected material was analysed for the presence of high-risk HPV ( using Hybrid capture 2; Hc2). Women with a positive HPV test were referred for colposcopy. These results were compared with the results of Pap smear screening in a corresponding age group of women ( controls). The end point of the study was identification of a histological cervical intraepithelial neoplasia stage 2 (CIN2) and above (CIN2+). Results In all, 39.4% ( n = 1426) women participated and 4.6% ( n = 66) were high-risk HPV positive. Of the HPV-positive women 56 chose to attend a surgery (84.8%) after a mean time of 2.1 months and ten of these women (17.9%) showed CIN2+, corresponding to 0.70% of all participating women. In the controls, who participated in organised Pap smear screening, the prevalence of CIN2+ was 0.25%(15/6048). The odds ratio for identification of CIN2+ in women aged 50 years or older performing self-sampling and HPV test in comparison with Pap smear was: 2.84 (95% CI 1.14-6.77, P = 0.0174). In older women primary high-risk HPV testing ( Hc2) and Pap smear screening showed equal specificity of around 96%. Conclusions Self-sampling of vaginal fluid in combination with high-risk HPV testing appears to be an attractive method to improve screening coverage and decrease the prevalence of cervical cancer in women aged 50 years or older.
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