In Örebro County, Sweden, the organized screening program includes women between 23 and 60. Women with normal cytology exit the program at 55-60 years of age. The aim of this study was to investigate if self-tests for elderly women could be an alternative to professionally taken samples.
All women (between 55-60) with normal cytology by liquid based cytology (LBC) in their exit sample during the years 2012-2014, a total of 2027, were invited to participate in the study. Retrospectively, all samples, previously biobanked at -25C, were genotyped for HPV with CLART HPV2 (Genomica), which detects 35 different low and high risk genotypes. 247 of 2027 women (12.2%) were positive for any of the 35 HPV genotypes. Of these, 154/247 carried an intermediate or high risk HPV according to the IARC classification, group 1 and 2A and B.
All 154 women were invited for a new cervical sampling, performed by a midwife, after a minimum of 6 months since the exit sample, and where at the same time given a self-sampling device, Rovers Evalyn brush, to use a week after the professional sampling.
A total of 118 of the 154 women returned a self -test. Of these, 66 were positive for a group 1 or 2 genotype. For the professional sampling, the corresponding number was 70 (McNemar test p=0.557). 42 of the self-sampled tests were negative for HPV and 10 had low risk genotypes only. Among the professionally collected samples, 40 were negative and 8 positive for low risk types.
The exact same result between professional and self-collected samples was seen in 67/118 samples (56.7%). Of those, 22 harbored an IARC group 1 genotype and 11 an IARC group 2 genotype. 31 samples were unanimously negative for HPV and 9 were concordant multi-infected samples.
Disconcordant results were noted in the remaining 51. Divergence was noted for both high and low risk results between the compared methods. Interestingly, 12 of the group 1 and 2 results in the self-collected samples could not be verified in the professionally collected samples. Also, 13 of group 1 and 2 results in the professional collected samples results were not found in the samples that were self-collected.
Although cervical self-sampling for HPV testing in elderly women should not be solely used, it could be offered as a complement to professionally collected samples.