Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Regional Cancer Center, Uppsala, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Eur J Obstet Gynecol Reprod Biol. 2022 Jan;268:68-73. doi: 10.1016/j.ejogrb.2021.11.430. Epub 2021 Nov 26.
Non-participation in screening is a main risk factor for cervical cancer. Human-papillomavirus (HPV) self-sampling may be an alternative to repeated invitations for non-attenders. Several studies have concluded that participation among non-attenders increases significantly when offering self-sampling kits for HPV. However, participation rates are highly variable between settings, and therefore pilots to determine optimal implementation strategy have been recommended before routine roll out.
All women who had not participated in the organized screening program for at least 10 years aged 33-62 in one Swedish county were identified through screening registers. HPV self-sampling kits were sent to all eligible women. Participation was defined as returning a self-sample kit or attending routine screening within 6 months. Women who did not submit the kit within 8 weeks were randomized to receive a written reminder. HPV-positive women were referred directly to colposcopy without prior triage. Biopsies for histopathologic confirmation were used as gold standard.
Among eligible women, 150/741 (20.2%) returned the self-sample kit or attended routine screening. A randomized written reminder was sent out to 319/591 non-responders and another 11 women returned the kit. In total, 23/147 (16.3%) of returned kits were HPV positive. Out of the 23 HPV-positive women, 17 (74%) attended colposcopy; 10/17 (59%) had a histopathological high-grade squamous intraepithelial lesions (HSIL) or cervical cancer. The most common HPV type was HPV 52, and 2 out of 3 women with HPV 16 had a histopathologically confirmed cancer.
The direct send kit strategy and referral of all HPV-positive women to colposcopy without prior triage appears to be feasible if resources are available and should be prioritized given the high prevalence of HSIL lesions and cancer among non-attenders. A written reminder might further increase attendance.
不参与筛查是宫颈癌的主要危险因素。人乳头瘤病毒（HPV）自我采样可能是一种替代反复邀请不参与者的方法。几项研究得出结论，当为非参与者提供 HPV 自我采样试剂盒时，参与率会显著增加。然而，在常规推出之前，已经建议进行试点以确定最佳实施策略，因为不同设置之间的参与率差异很大。
通过筛查登记册确定了瑞典一个县所有至少 10 年未参加有组织筛查计划的年龄在 33-62 岁的女性。向所有符合条件的女性发送 HPV 自我采样试剂盒。参与被定义为返回自我采样试剂盒或在 6 个月内参加常规筛查。在 8 周内未提交试剂盒的女性被随机分配接受书面提醒。HPV 阳性女性无需事先分诊即可直接转至阴道镜检查。活检用于组织病理学确认作为金标准。
在符合条件的女性中，150/741（20.2%）人返回了自我采样试剂盒或参加了常规筛查。向 319/591 名未回复者发送了随机书面提醒，另有 11 名女性返回了试剂盒。总共，23/147（16.3%）返回的试剂盒 HPV 阳性。在 23 名 HPV 阳性女性中，17 人（74%）接受了阴道镜检查；10/17（59%）患有组织学高级别鳞状上皮内病变（HSIL）或宫颈癌。最常见的 HPV 类型是 HPV 52，在 3 名 HPV 16 女性中，有 2 人患有组织病理学证实的癌症。
如果资源可用，直接发送试剂盒策略和将所有 HPV 阳性女性转至阴道镜检查而无需事先分诊似乎是可行的，鉴于非参与者中 HSIL 病变和癌症的高患病率，应优先考虑。书面提醒可能会进一步提高出勤率。
