title: Human papillomavirus testing on self-sampled cervicovaginal brushes: an effective alternative to protect nonresponders in cervical screening programs.
abstract: Women not attending cervical screening programs are at increased risk of cervical cancer. We investigated in these nonresponders to what extent offering self-sampling devices for cervicovaginal brushes for high-risk human papillomavirus (hrHPV) testing would induce participation and, if so, what the yield of precursor (i.e. CIN2 or worse) lesions following self-sampling would be. In addition, we assessed screening history of participants and costs per detected high-grade CIN2 or worse ("CIN2+") lesion in comparison to the regular program in the Netherlands. Nonresponders received a device for hrHPV testing (self-sampling group, n=2,546) or an extra recall for conventional cytology (control group, n=284). The percentage of self-sampling responders were compared with responders in the recall group. hrHPV positive self-sampling responders were invited for cytology and colposcopy. CIN2+ yield and costs per detected CIN2+ were evaluated. Active response was higher in the self-sampling than in the control group (34.2 vs. 17.6%; p<0.001). hrHPV positive self-sampling responders were less likely to have a prior screening history than screening participants (p<0.001), indicating that they are regular nonresponders. hrHPV prevalence was similar (8.0 vs. 6.8%; p=0.11), but CIN2+ yield was higher in self-sampling responders compared to screening participants (1.67 vs. 0.97%; OR=2.93, 95% CI 1.48-5.80; p=0.0013). Costs per CIN2+ lesion detected via self-sampling were in the same range as those calculated for conventional cytological screening (euro 8,836 vs. euro 7,599). Offering self-sampling for hrHPV testing in nonresponders is an attractive adjunct to effectively increase population coverage of screening without the adverse effect of markedly increased costs per detected CIN2+ lesion.
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Aagje G
authors.initials: AG
authors.lastname: Bais
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: van Kemenade
authors.forename: Johannes
authors.initials: J
authors.lastname: Berkhof
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
authors.forename: Peter J F
authors.initials: PJ
authors.lastname: Snijders
authors.forename: Feja
authors.initials: F
authors.lastname: Voorhorst
authors.forename: Milena
authors.initials: M
authors.lastname: Babović
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Helmerhorst
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
mesh_terms: D002278:Carcinoma in Situ / Q000453:epidemiology / Q000235:genetics / Q000821:virology; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000235:genetics; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000235:genetics / Q000821:virology