HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: cohort study

• Published in: BMJ 2010-03, Vol.340 (7752), p.905-905
• Main Authors: Gök, Murat, Heideman, Daniëlle A M, van Kemenade, Folkert J, Berkhof, Johannes, Rozendaal, Lawrence, Spruyt, Johan W M, Voorhorst, Feja, Beliën, Jeroen A M, Babović, Milena, Snijders, Peter J F, Meijer, Chris J L M
• Format: Article
• Language: English
• Subjects: Adult; Carcinoma; Cervical Cancer; Cervical Intraepithelial Neoplasia - prevention & control; Cervical Intraepithelial Neoplasia - virology; Cervical Screening; Cervix Uteri - virology; Colposcopy; Cytology; Early Detection of Cancer; Epidemiologic Studies; Female; General Practice / Family Medicine; General Surgery; Gynecological Cancer; Human papillomavirus; Humans; Mass Screening - methods; Medical screening; Middle Aged; Netherlands; Papillomavirus Infections - diagnosis; Patient Compliance; Screening (Epidemiology); Screening (Oncology); Screening (Public Health); Screening questions; Screening tests; Self Care; Specimen Handling; Specimens; Surgical Diagnostic Tests; Therapeutic Irrigation; Transponders; Uterine Cervical Neoplasms - prevention & control; Uterine Cervical Neoplasms - virology; Vagina - virology; Vaginal Smears; Womens health
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.c1040

Objective To determine whether offering self sampling of cervicovaginal material for high risk human papillomavirus (HPV) testing is an effective screening method for women who do not attend regular cervical screening programmes.Design Cohort study (the PROHTECT trial).Settings Noord-Holland and Flevoland regions of the Netherlands, December 2006 to December 2007, including 13 laboratories, gynaecologists, and more than 800 general practitioners.Participants 28 073 women who had not responded to two invitations to the regular cervical screening programme: 27 792 women were assigned to the self sampling group and invited to submit a self collected cervicovaginal sample for HPV testing; 281 were assigned to the recall control group and received a second re-invitation for conventional cytology.Intervention Women with a positive result on the high risk HPV test on their self sample material were referred to their general practitioner. Women with abnormal results on cytology were referred for colposcopy. Women with normal results on cytology were re-evaluated after one year by cytology and high risk HPV testing and referred for colposcopy if either result was positive.Main outcome measures Attendance rate in both groups and yield of cervical intraepithelial neoplasia grade II/III or worse (≥CIN II/≥CIN III) in self sampling responders.Results The compliance rate in the self sampling group was significantly higher than in the control group (crude 26.6% v 16.4%, P