Center for Cervical Cancer Elimination, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Center for Cervical Cancer Elimination, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Int J Cancer. 2025 Jan 15;156(2):379-388. doi: 10.1002/ijc.35142. Epub 2024 Aug 15.
In well-screened populations, most cervical cancers arise from small groups of women with inadequate screening. The present study aims to assess whether registry-based cancer risk assessment could be used to increase screening intensity among high-risk women. The National Cervical Screening Registry identified the 28,689 women residents in Sweden who had either no previous cervical screening or a screening history indicating high risk. We invited these women by SMS and/or physical letter to order a free human papillomavirus (HPV) self-sampling kit. The Swedish national HPV reference laboratory performed extended HPV genotyping and referred high-risk HPV-positive women to their regional gynecologist. A total of 3691/28,689 (12.9%) women ordered a self-sampling kit and 10.0% (2853/28,689) returned a sample for testing. Participation among women who had never attended screening was low, albeit improved. Up to 22.5% of women in other high-risk groups attended. High-risk HPV types were detected in 8.3% of samples. High-risk HPV-positive women (238/2853) were referred without further triaging and severe cervical precancer or cancer (HSIL+) in histopathology were detected in 36/158 (23%) of biopsied women. Repeat invitations gave modest additional participation. Nationwide contacting of women with high risk for cervical cancer with personal invitations to order HPV self-sampling kits resulted in high yield of detected CIN2+. Further efforts to improve risk-stratified screening strategies should be directed to improving (i) the precision of the risk-stratification algorithm, (ii) the convenience for the women to participate and, (iii) ensuring that screen-positive women are followed-up.
在筛查良好的人群中，大多数宫颈癌是由一小部分筛查不足的妇女引起的。本研究旨在评估基于登记的癌症风险评估是否可用于增加高危妇女的筛查强度。国家宫颈筛查登记处确定了居住在瑞典的 28689 名妇女，她们要么没有以前的宫颈筛查史，要么筛查史表明她们处于高风险。我们通过短信和/或实物信件邀请这些妇女订购免费的人乳头瘤病毒（HPV）自我采样试剂盒。瑞典国家 HPV 参考实验室进行了 HPV 扩展基因分型，并将高危 HPV 阳性妇女转介给她们所在地区的妇科医生。共有 28689 名妇女中的 3691 名（12.9%）订购了自我采样试剂盒，10.0%（2853 名）的妇女返回样本进行检测。从未参加过筛查的妇女参与率很低，但有所提高。多达 22.5%的其他高风险组妇女参加了。在 2853 份样本中检测到高危 HPV 型。高危 HPV 阳性妇女（238 名）未经进一步分诊即被转介，在活检妇女中 36 名（23%）的组织病理学检测出高级别宫颈上皮内瘤变（HSIL+）。重复邀请只带来了适度的额外参与。在全国范围内，通过个人邀请高危宫颈癌妇女订购 HPV 自我采样试剂盒，检测到了大量的 CIN2+。进一步努力改善风险分层筛查策略应针对以下三个方面进行：（i）提高风险分层算法的精度，（ii）提高妇女参与的便利性，以及（iii）确保对筛查阳性妇女进行随访。
