Comparison between professional sampling and self‐sampling for <scp>HPV</scp>‐based cervical cancer screening among postmenopausal women

Bergengren, Lovisa; Kaliff, Malin; Lillsunde-Larsson, Gabriella; Karlsson, Mats G.; Helenius, Gisela

doi:10.1002/ijgo.12538

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…As succinctly stated in a previous study ( 50 ): ‘The new imperatives of the COVID-19 pandemic support self-sampled HPV testing as the primary cervical screening method’. That conclusion is justified, given the reliability of self-sampling ( 25 , 54 – 57 ), together with its acceptability and cost-effectiveness ( 27 , 58 – 63 ).…”

Section: Discussionmentioning

confidence: 98%

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

et al. 2021

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The present study aimed to identify the factors that independently contribute to disease recurrence among women first-time treated for high-grade cervical intraepithelial neoplasia (CIN) during 4-6 years of follow-up. Overall, 529 of 530 eligible patients participated; these patients all attended a 1st follow-up appointment ~6 months post-conization, at which time high-risk human-papillomavirus (HPV) testing, liquid-based cytology and colposcopy were performed. Full data on margin excision status, other aspects of initial treatment and comorbidity were obtained. At least one subsequent follow-up was attended by 88% of patients. A total of 22 recurrent cases were detected during follow-up. Detected recurrence was the outcome of focus for multiple logistic regression analysis, with odds ratios (OR) and 95% confidence intervals (CI) computed. Four significant independent risk factors were identified: Age 45 years or above (OR=3.5, 95% CI=1.3-9.9), one or both unclear or uncertain margins (OR=5.3, 95% CI=2.0-14.2), positive HPV at 1st follow-up (OR=5.8, 95% CI=2.0-16.8), and abnormal cytology at 1st follow-up (OR=3.9, 95% CI=1.4-11.0). Bivariate analysis revealed that persistent HPV positivity was associated with recurrence (P<0.01). These findings indicated that incomplete excision of the CIN lesion may warrant more intensive subsequent screening, regardless of early post-conization HPV findings. Although early post-conization positive HPV was a powerful, independent predictor of recurrent high-grade CIN, over one-third of the patients with detected recurrence had a negative early post-conization HPV finding. These patients returned for routine screening, at which time, in most cases, HPV status was positive, thus indicating the need for repeated HPV evaluation. Especially during the on-going pandemic, home vaginal self-sampling is recommended. Particular attention is required for women aged ≥45 years. In addition, although not statistically significant, relevant comorbidities, especially autoimmune conditions, warrant consideration in clinical decision-making. Women who have been treated for high-grade CIN are at risk for recurrent disease and progression to cervical cancer; therefore, they require careful, individualized follow-up to avoid these adverse consequences.

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Section: Discussionmentioning

confidence: 98%

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

et al. 2021

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“…Numerous authors have suggested self-sampling for HPV as a viable cervical screening option, especially in face of the pandemic (37,41,(44)(45)(46)(47)(48). Overall, self-sampling for HPV has been shown to be reliable (25,(49)(50)(51)(52), cost-effective (53) and acceptable among diverse populations, including women who are under-screened (54)(55)(56)(57)(58)(59).…”

Section: Discussionmentioning

confidence: 99%

“…The HPV tests in use at Karolinska at the time of the study were Cobas 4800 (Roche Molecular Diagnostics), Hybrid Capture 2 HPV DNA Test (Qiagen), and Linear Array HPV Genotyping Test (Roche Molecular Systems). Results were considered positive if any high-risk HPV: [ 16 , 18 , 31 , 33 , 35 , 39 , 45 , 51 , 52 , 56 , 58 , 59 , 68] or potentially high-risk: [ 26 , 53 , 66, 68, 73, 82] types were identified.…”

Section: Methodsmentioning

confidence: 99%

Predictors of treatment failure for adenocarcinoma in situ of the uterine cervix: Up to 14 years of recorded follow‑up

et al. 2022

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The incidence of adenocarcinoma-in-situ (AIS) of the uterine cervix is rising, with invasive adenocarcinoma becoming increasingly common relative to squamous cell carcinoma. The present study reviewed a cohort of 84 patients first-time treated by conization for histologically-confirmed AIS from January 2001 to January 2017, to identify risk factors associated with recurrent/persistent AIS as well as progression to invasive cervical cancer. Nearly 80% of the patients were age 40 or younger at conization. Endocervical and ectocervical margins were deemed clear in 42 of the patients. All but two patients had ≥1 follow-up, with post-conization high-risk human papilloma virus (HPV) results documented in 52 patients. Altogether, 12 histopathologically-confirmed recurrences (14.3%) were detected; two of these patients had microinvasive or invasive carcinoma. In three other patients cytology showed AIS, but without recorded histopathology. Eight patients underwent hysterectomy for incomplete resection very soon after primary conization; they were not included in bivariate or multivariate analyses. Having ≥1 post-follow-up positive HPV finding yielded the highest sensitivity for histologically-confirmed recurrence: 87.5 [95% confidence interval (CI) 47.4-99.7]. Current or historical smoking status provided highest specificity: 94.4 (95% CI 72.7-99.9) and overall accuracy: 88.0 (95% CI 68.8-97.5) for histologically-confirmed recurrence. With multiple logistic regression (MLR), adjusting for age at conization and abnormal follow-up cytology, positive HPV18 was the strongest predictor of histologically-confirmed recurrence (P<0.005). Having ≥2 positive HPV results also predicted recurrence (P<0.02). Any unclear margin yielded an odds ratio 7.21 (95% CI 1.34-38.7) for histologically-confirmed recurrence adjusting for age, but became non-significant when including abnormal cytology in the MLR model. The strong predictive value of HPV, particularly HPV18 and persistent HPV positivity vis-à-vis detected recurrence indicated that regular HPV testing for patients treated for AIS is imperative. In conclusion, furthering a participatory approach, including attention to smoking with encouragement to attend needed long-term follow-up, can better protect these patients at high risk for cervical cancer.

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“…It is also well known that a single HPV test is associated with a modest specificity that can be significantly improved with repeated testing [11, 12]. Vaginal self-sampling for HPV testing has been extensively studied, and results from self-sampling are fully comparable with samples collected by a healthcare provider (HCP), as long as a sensitive PCR-based method is used [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Cervical dysplasia in elderly women performing repeated self-sampling for HPV testing

et al. 2018

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BackgroundAbout 30% of the cervical cancer cases in Sweden occur in women older than 60. The primary aim was to evaluate the acceptability of repeated self-sampling at home for HPV-testing in elderly women. The prevalence of HPV and HPV related dysplasia as well as the sensitivity of cytology was evaluated.MethodsRepeated self-sampling at home for HPV testing was offered 375 women in each of the four age groups 60, 65, 70 and 75 years. Women with two consecutive positive HPV tests were examined with sampling for histology and cytology.FindingsA self-sample was provided by 59.5% (893/1500) of the invited women. The overall prevalence of HPV was 4.4% (95% CI 3.2–6.0, n = 39) in the first test, and 2.5% were persistent positive in the second test (95% C 1.6–3.8, n = 22) collected on average 5.5 months later. Dysplasia, was found in 1.8% (16/893) (95% CI 1.1–3.0) and CIN 2+ in 1.0% (9/893) (95%CI 0.5–2.0) of the women. Of the 16 women with dysplasia in histology, 13 (81.2%) had a normal cytology.InterpretationRepeated self-sampling at home combined with HPV testing was well accepted among elderly women. A high prevalence of CIN was diagnosed by histology. Cytology showed extremely low sensitivity and should not be recommended for this age group.

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Comparison between professional sampling and self‐sampling for HPV‐based cervical cancer screening among postmenopausal women

Abstract: Postmenopausal women could be offered self-sampling devices to increase screening-program coverage while maintaining test quality.

Cited by 8 publications

References 21 publications

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

Predictors of treatment failure for adenocarcinoma in situ of the uterine cervix: Up to 14 years of recorded follow‑up

Cervical dysplasia in elderly women performing repeated self-sampling for HPV testing

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