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Self-sampling for H...
Self-sampling for HPV testing in primary cervical screening : Including clinical and health economic aspects
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- Aarnio, Riina (författare)
- Uppsala universitet,Reproduktionsbiologi
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- Olovsson, Matts, 1958- (preses)
- Uppsala universitet,Reproduktionsbiologi
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- Gyllensten, Ulf B. (preses)
- Uppsala universitet,Science for Life Laboratory, SciLifeLab,Uppsala kliniska forskningscentrum (UCR),Medicinsk genetik och genomik
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- Wikström, Ingrid, 1949- (preses)
- Uppsala universitet,Reproduktionsbiologi
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- Borgfeldt, Christer, Professor (opponent)
- Lunds University, Department of Obstetrics and Gynecology
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(creator_code:org_t)
- ISBN 9789151308821
- Uppsala : Acta Universitatis Upsaliensis, 2020
- Engelska 81 s.
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Serie: Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1651-6206 ; 1641
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Abstract
Ämnesord
Stäng
- Persistent infection with high-risk human papillomavirus (HPV) is a prerequisite for the development of cervical cancer. HPV testing has higher sensitivity for high-grade cervical intraepithelial neoplasia (CIN2+) than cytology, resulting in more effective screening. As HPV testing also offers an opportunity for self-sampling, it could serve as an even more effective and cost-effective method of cervical screening.First, we compared repeated self-sampling for HPV testing with Pap smear cytology in detection of CIN2+ in primary cervical screening for women aged 30–49 years (n=36 390). We found a more than twofold higher detection rate of CIN2+ and a fourfold higher detection rate of CIN2 with self-sampling compared with cytology. However, no difference was seen between the arms in the detection rate of CIN3+. It thus seems that CIN is detected at an earlier stage with self-sampling than with cytology, but the impact of this needs to be further explored.Second, as management of HPV-positive women with normal cytology results is a challenge, we wanted to evaluate the proportion of cases of histological CIN2+ in these women. In this prospective study we performed LEEP and found that 15% (6/40) of the women had undetected CIN2+. These findings can be used in counseling women about the risk of cervical cancer and helping clinicians in decisions on management.Third, we performed a cost-effectiveness analysis on the same study population as in Study I. Self-sampling for HPV testing resulted in a higher participation rate and more detected cases of CIN2+ at a lower cost and was regarded as more cost-effective than Pap smear cytology in cervical screening. These results can guide policy-makers when planning future screening programs.Fourth, we compared self-sampling with sampling by medical professionals for HPV testing in detection of CIN2+, using a combination of an FTA card as storage medium and a PCR-based HPV test (hpVIR) in women aged 30–60 years (n=11 951). No difference in the detection rates of histological CIN2+ was found between the arms.Taken together, self-sampling resulted in a higher participation rate than sampling by medical professionals in cervical screening and that triage with repeated self-sampling resulted in high compliance and detection rate of CIN2+. As repeated self-sampling for HPV testing was also cost-effective, it could serve as an attractive alternative in the development of future cervical screening programs. More research is needed on how to refine the management of HPV-positive women by self-sampling only.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
Nyckelord
- HPV
- self-sampling
- cervical screening
- CIN2
- cost-effectiveness
- Obstetrik och gynekologi
- Obstetrics and Gynaecology
Publikations- och innehållstyp
- vet (ämneskategori)
- dok (ämneskategori)
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