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Background: The efficacy of cervical cancer screening programs is dependent on the participation rate. To increase participation among women not attending cervical cancer screening, self-collected samples for detection of highrisk human papillomavirus (hr-HPV) may be an option. The aims of this study were: to investigate the response rate to sending a self-collected vaginal sample for hr-HPV mRNA detection to long-term non-attendees; the compliance with follow-up among women positive for HPV in the self-sample; the prevalence of cervical dysplasia (high grade squamous intraepithelial lesion (HSIL), atypical squamous cells that cannot exclude HSIL (ASC-H) or adenocarcinoma in situ (AIS)) or cancer among the responders; as well as to explore reasons for not returning a self-sample. Methods: A vaginal self-sampling kit was sent to 6023 women aged 30-70 years who had not provided a cervical screening sample for ≥7 years in the Region of Skåne, Sweden in November and December 2017. The self-sample was analyzed by Aptima HPV mRNA assay (Hologic). All vaginal self-samples returned no later than May 31, 2018 were included in the study. Follow-up of the results was registered until January 31, 2019 with a follow-up time varying between eight to 14 months. Women positive for hr-HPV mRNA were invited for a follow-up examination. This examination consisted of a cervical sample for cytological analysis and renewed Aptima HPV mRNA testing. Two hundred thirty-five women who had not returned the self-sample were randomly selected for telephone interviews, in order to explore their reasons. Results: The response rate for the self-collected vaginal hr-HPV sample was 13.2% [(797/6023), 95% CI 12.4-14.1%] and 9.9% [(79/796), 95% CI 7.9-12.2%] were positive for hr-HPV mRNA. The prevalence of severe dysplasia or cancer in the whole group of responders was 1.3% [(10/796), 95% CI 0.6-2.3%], with a cervical cancer prevalence of 0.4% [(3/796), 95% CI 0.1-1.1%]. Only 27 women participated in the telephone interviews, no particular reason for not returning self-samples was observed. Conclusions: Self-collected vaginal hr-HPV samples increased participation in the cervical cancer screening among long-term non-attendees. The prevalence of cervical cancer was almost seven times higher for long-term nonattendees than in the organized screening population.

Background/Aim: Cervical cancer is associated with poorer diagnosis among the elderly and pap-smear screening has a lower sensitivity. Self-sampling for detection of high-risk human papillomavirus (hr-HPV) may be an alternative screening method. The aim of this study was to analyze the response rate to vaginal HPV self-sampling and the HPV mRNA prevalence among women 69-70 years. Materials and Methods: An HPV self-sampling kit was sent to 1,000 women 69-70 years whom had not taken a cervical smear in ≥5 years. The samples were analyzed by the Aptima HPV mRNA assay. HPV-positive women were recalled for a follow-up examination. Results: The self-sample response rate was 43.3%. The HPV mRNA prevalence was 6.2%. All HPV-positive women attended follow-up. Conclusion: HPV self-sampling was accepted among older women. Although the HPV mRNA prevalence was 6.2%, no high-grade cytological abnormalities were found. Larger studies are needed to elucidate hr-HPV self-sampling as a tool to identify older women at risk of cervical cancer.In 2017 one out of five people were 65 years or older in Sweden and the number of people 80 years and older are expected to increase by 50% in less than 30 years (1). Cervical cancer is one of the most common cancers among women globally (2). Some studies show a bimodal distribution of cervical cancer incidence with a first peak among younger women around the age of 40 and a second peak among older women around the age of 65-79 (3, 4). In a Danish study, it was observed that the peak incidence of cervical cancer will shift to 75-79 years of age when correcting for hysterectomy (4). Considerations must be taken because cervical cancer is not only a disease of young women, but also an important disease in the elderly. Several previous studies have shown that older women to a greater extent are diagnosed with an advanced-stage disease (3, 5-9) and the prognosis is poor (7, 8). A pap smear has a lower sensitivity among postmenopausal women (10) as the transformation zone moves upwards into the cervical canal (11,12) in this age group, contributing to a higher risk of clinical sampling errors which may miss women with cervical dysplasia or invasive cancer.There is no consensus at what age to stop screening for cervical cancer. According to European guidelines, screening with cytology or human papillomavirus (HPV) could be stopped around 60-65 years, given the woman has had a recent negative test (13). In Sweden, the organized screening program for cervical cancer comprises women 23-64 years old, but the women must be recalled at the age of 70 years if no test is registered after the age of 64 years (11). A paradigm shift for cervical cancer screening is currently under way in several countries. Persistent infection with high-risk HPV (hr-HPV) is the main reason for 99.7% of cervical dysplasia and invasive cervical cancer (14). Screening for hr-HPV types has been shown to be more effective in preventing invasive cervical cancer compared to cytology for women ≥30 years, hence this method is now recomm...