Ernstson Avalon, Forslund Ola, Borgfeldt Christer
Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Medical Microbiology, Laboratory Medicine Region Skåne, Lund University, Lund, Sweden.
J Cancer Prev. 2021 Mar 30;26(1):25-31. doi: 10.15430/JCP.2021.26.1.25.
Cervical cancer is preventable through gynecological screening. To promote participation among non-attending women, self-collected vaginal samples for detection of high-risk human papillomavirus (hr-HPV) is an option. The aims of this study were to investigate the response of self-collected vaginal samples for hr-HPV testing among long-term non-attendees, to explore the attendance at follow-up among HPV-positive women, and to analyze the prevalence of hr-HPV and severe cervical dysplasia or cancer among the responders. A vaginal self-sampling kit was sent to 19,766 women aged 30-70 years who had not provided a cervical screening sample for ≥ 7 years in Skåne, Sweden. The self-sample was analyzed by the Aptima HPV mRNA assay (Hologic). Women testing positive for HPV were invited for follow-up. The response was 18.5% (3,646/19,757). The prevalence of HPV mRNA was 11.3% (412/3,636). Among HPV-positive women, 85.7% (353/412) attended follow-up, and of these, 44.8% (158/353) had HPV in the cervical sample. The HPV mRNA test of self-samples showed a positive predictive value of 9.3% ([33/353], 95% CI = 6.5-12.9) for detection of cytologically severe dysplasia. Histologically severe dysplasia or cancer was detected in 0.88% ([32/3,636], 95% CI = 0.6-1.2) among responders, including two cervical- and one vaginal cancer. In conclusion, almost one fifth of the long-term non-attendees participated in self-collected vaginal hr-HPV sampling. The prevalence of histologically confirmed high grade squamous intraepithelial lesion or cervical cancer was not increased significantly compared to regularly screened women in Sweden. The relatively high HPV prevalence among the self-samples indicates the importance of diagnostic follow-up with cervical HPV testing and reflex-cytology of HPV-positive cases.
宫颈癌可通过妇科筛查预防。为提高未参加筛查女性的参与度，自行采集阴道样本检测高危型人乳头瘤病毒（hr-HPV）是一种选择。本研究旨在调查长期未参加筛查女性对自行采集阴道样本进行hr-HPV检测的反应，探讨HPV阳性女性的随访就诊情况，并分析应答者中hr-HPV及严重宫颈发育异常或癌症的患病率。向瑞典斯科讷地区19766名30至70岁、至少7年未提供宫颈筛查样本的女性发送了阴道自采样试剂盒。自行采集的样本采用Aptima HPV mRNA检测法（Hologic公司）进行分析。HPV检测呈阳性的女性被邀请进行随访。应答率为18.5%（3646/19757）。HPV mRNA患病率为11.3%（412/3636）。在HPV阳性女性中，85.7%（353/412）参加了随访，其中44.8%（158/353）宫颈样本中检测到HPV。自行采集样本的HPV mRNA检测对细胞学重度发育异常检测的阳性预测值为9.3%（[33/353]，95%CI = 6.5-12.9）。在应答者中，组织学上重度发育异常或癌症的检出率为0.88%（[32/3636]，95%CI = 0.6-1.2），包括2例宫颈癌和1例阴道癌。总之，近五分之一的长期未参加筛查女性参与了自行采集阴道hr-HPV采样。与瑞典定期筛查的女性相比，组织学确诊的高级别鳞状上皮内病变或宫颈癌的患病率没有显著增加。自行采集样本中相对较高的HPV患病率表明，对HPV阳性病例进行宫颈HPV检测和反射细胞学诊断随访很重要。
