5 ECCA (European cervical cancer association) Brussels, Belgium Today in France, low attendance to cervical screening by Papanicolaou cytology (Pap-smear) is a major contributor to the 3,000 new cervical cancer cases and 1,000 deaths that occur from this disease every year. Nonattenders are mostly from lower socioeconomic groups and testing of self-obtained samples for high-risk Human Papilloma virus (HPV) types has been proposed as a method to increase screening participation in these groups. In 2011, we conducted a randomized study of women aged 35-69 from very low-income populations around Marseille who had not responded to an initial invitation for a free Pap-smear. After randomization, one group received a second invitation for a free Pap-smear and the other group was offered a free self-sampling kit for HPV testing. Participation rates were significantly different between the two groups with only 2.0% of women attending for a Pap-smear while 18.3% of women returned a self-sample for HPV testing (p 0.001). The detection rate of high-grade lesions ( CIN2) was 0.2& in the Pap-smear group and 1.25& in the self-sampling group (p 5 0.01). Offering self-sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions ( CIN2) in comparison to the group of women receiving a second invitation for a Pap-smear. However, low compliance to follow-up in the self-sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.Cervical cancer screening with Papanicolaou cytology (Papsmear) has markedly decreased cervical cancer rates in those high-income countries where it has been effectively implemented. In France, from 1980 to 2009, age standardized incidence rates (world population) decreased from 14.9 to 6.4/ 100,000, while cervical cancer mortality decreased from 5.4 to 1.7/100,000. 1 Irregular or nonattendance to screening is the principal cause of the 3,000 new cervical cancers diagnosed annually in France today and which lead to 1,000 deaths each year. Various studies show that 60-65% of women diagnosed with invasive cervical cancer have not been regularly screened. 2 In France, cervical screening is opportunistic but the widespread availability of services combined with cultural factors has led to good coverage of the target population and irregular or nonattenders are now mostly from lower socioeconomic groups or women over the age of 55 years with cultural barriers toward clinical gynecological examination. 3,4 One project to increase the participation rate in these groups introduced an organized screening process for women living in the northern suburbs of Marseille (France) where the majority are immigrants living on low incomes. In 2001, women with no Pap-smears recorded during the past 2 years were sent a personal letter inviting them to consult their general practitioner for a free Pap-smear but only 1.8% of the women participated. In 2003, the process was repeated with women invited to have a free Pap-sm...

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Direct digital mammography has a higher detection rate than film-screen mammography in dense breasts and for tumors of high grade. This latter association warrants further study to measure the impact of technology on efficacy of screening. The data indicate that computed radiography detects fewer tumors than film-screen mammography in most instances.

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Self-sampling using vaginal swabs could be a valuable alternative to screen for 4 cervical cancer for women who do not attend regular cytological screening. The aim 5 of this study was to determine the prevalence of high and low-risk HPV types and of 6 HPV type 16 and 18 DNA load in self-collected vaginal swabs from 35-to 69-year-old 7Southern French women of low socioeconomic level or migrant populations who do 8 not attend regular cervical screening. A good concordance (93.1%) was found 9 between cervical brush and vaginal swabs in 29 samples. Self-collected vaginal 10 swabs were examined from 120 women. HPV infection was found in 28 women 11 (23.3%; median age 48 years), 17 (14.1%) of whom harboured high-risk HPV types. 12 HPV type 16 was the high risk type found most frequently, followed by types 53, 31, 13 18, 58, and 66. The low-risk type detected most frequently was HPV type 6, followed 14 by types 61, 70, and 81. The mean HPV 16 and 18 load was 6.3 log 10 copies/10 6 15 cells and 2.4 log 10 copies/10 6 cells, respectively. These results suggest that vaginal 16 self-swabs can be a reliable tool for cervical cancer screening in non-attending and 17 inadequately screened elderly women. 18 19Key Words: human papillomavirus; viral load; cervical cancer; self-obtained vaginal 20 swabs; low economic class women; high-risk and low-risk HPV types.