Cancer detection using human papillomavirus self-sampling targeting long-term non-attenders in an organized cervical screening program.

Self-sampling for human papillomavirus (HPV) is an established strategy to increase participation in cervical screening. We previously reported a randomized trial targeting women who had not attended screening after >10 invitations, where sending of self-sampling kits resulted in a 19% attendance and a positive predictive value (PPV) for high grade lesions (HSIL+) of 40%, despite no triaging after the HPV test. Because of the striking results, the intervention was extended to all women resident in Stockholm County, Sweden, in the years 2019/20, who had not attended screening >10 years (N = 42,409). Participation was 35.6% and 11.6% of the participating women were HPV-positive. Among these, there were 43 cases of invasive cervical cancer and 319 cases of high-grade lesions. The PPV was particularly high for HPV16/18 positive women (12% for invasive cancer and 59% for HSIL). In summary, participation with HPV self-sampling among long-term non-attenders in the real-life program was considerably higher than in the research setting and the high yield of HSIL+ implied high effectiveness.