title: Short-time repeat high-risk HPV testing by self-sampling for screening of cervical cancer.
abstract: BACKGROUND
  Testing for high-risk human papillomavirus (HPV) in primary screening for cervical cancer is considered more sensitive, but less specific, in comparison with Pap-smear cytology. Women with persistent HPV infections have a higher risk of developing cervical intraepithelial neoplasia 2+ (CIN2+) lesions. This study was performed to evaluate the gain in specificity for detection of histologically confirmed CIN2+ lesions achieved by short-time repeat testing for high-risk HPV in women aged 30-65 years, with the primary sample for HPV analysis taken by self-sampling.
  
  
  METHODS
  A total of 8000 women in Uppsala County, aged 30-65 years, who had not attended organised screening for 6 years or longer, were offered self-sampling of vaginal fluid at home and the samples sent for HPV typing. Of these, 8% (669) were not possible to contact or had performed hysterectomy. Women positive for high-risk HPV in the self-sampling test were invited for a follow-up HPV test and a cervical biopsy on average 3 months after the initial HPV test.
  
  
  RESULTS
  In all, 39% (2850/7331) of invited women chose to perform self-sampling of vaginal fluid at home. High-risk HPV infection was found in 6.6% (188) of the women. In all, 89% of the women testing HPV positive performed a follow-up examination, on average 2.7 months, after the first test and 59% of these women were HPV positive in the follow-up test. The prevalence of CIN2+ lesions in women with an initial HPV-positive test was 23% (95% CI 18-30%) and in women with two consecutive HPV-positive tests was 41% (95% CI 31-51%). In women with two positive HPV tests, the prevalence of CIN2+ lesions varied from 49% in women at age 30-39 years to 24% in women at age 50-65 years. Short-time repeat HPV testing increased the specificity for detection of CIN2+ lesions from about 94.2% to 97.8%. The most prevalent HPV types were HPV16 (32%), followed by HPV18/45 (19%) and HPV 33/52/58 (19%).
  
  
  CONCLUSIONS
  The short-time persistence of high-risk HPV infection in this age group was about 60%. Repeat testing for high-risk HPV using self-sampling of vaginal fluid can be used to increase the specificity in the screening for cervical cancer in women aged 30-65 years.
authors.affiliation: Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, SciLifeLab, Uppsala University Hospital, Uppsala, Sweden. ulf.gyllensten@igp.uu.se
authors.forename: U
authors.initials: U
authors.lastname: Gyllensten
authors.forename: K
authors.initials: K
authors.lastname: Sanner
authors.forename: I
authors.initials: I
authors.lastname: Gustavsson
authors.forename: M
authors.initials: M
authors.lastname: Lindell
authors.forename: I
authors.initials: I
authors.lastname: Wikström
authors.forename: E
authors.initials: E
authors.lastname: Wilander
mesh_terms: D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D059026:Diagnostic Self Evaluation; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D010507:Periodicity; D018570:Risk Assessment; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D014626:Vaginal Smears / Q000379:methods*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000209:etiology / Q000821:virology