{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:09:46Z","timestamp":1775693386123,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Most cervical cancer cases in Sweden are diagnosed among women who have failed to attend screening. The objective of this study was to analyze the effectiveness of offering vaginal HPV (human papillomavirus) self\u2010samples to long\u2010term non\u2010attendees as a routine in this screening program, in which non\u2010attendees had already been the targets of several interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>Register data from the organized cervical screening program were used in this population\u2010based study. From January 2016 to December 2019, 33\u2009881 high\u2010risk (hr\u2010) HPV self\u2010sample kits were sent to the homes of long\u2010term screening non\u2010attendees (\u22657\u2009years without a registered screening test), aged between 29 and 64\u2009years, in Region V\u00e4stra G\u00f6taland, Sweden. All samples returned to the laboratory were analyzed with the Cobas HPV DNA assay (Roche) for HPV16, HPV18, and for 12 other hr\u2010HPV types. HPV\u2010positive women were referred for colposcopy. Compliance and results of follow\u2010up were assessed 12\u2009months after HPV analysis. Descriptive statistics, trend analysis, and risk ratios were used to compare outcomes across groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age of invited women was 49\u2009years; 35% had not been screened before. The response rate was 19.4% (6582\/33881). The HPV prevalence was 12.0% (788\/6582), and 80.2% of HPV\u2010positive women attended follow\u2010up. Women with no previous cervical sample had a lower response rate: 15.7% (RR (Risk ratio) 0.73 (95% CI (Confidence interval) 0.70\u20130.77)). They also had lower attendance in follow\u2010up when HPV\u2010positive (71.6% RR 0.86 (CI 0.78\u20130.94)), compared with women who had previous samples. The proportions of high\u2010grade histopathology (HSIL+) among followed\u2010up women were 31.3% for HPV16, 15.2% for HPV18, and 8.8% for HPVnon\u201016\/18. Nine cervical cancer cases were found among 6582 women, corresponding to a rate of 137 cases per 100,000 women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vaginal HPV self\u2010samples increased cervical screening attendance by almost one\u2010fifth among non\u2010attendees who had previously resisted several invitations and interventions. Biopsied women positive for HPV16 or HPV18 had a high prevalence of HSIL or cervical cancer, which strongly supports direct referral to colposcopy. Long\u2010term non\u2010attendees have an exceptionally high risk of cervical cancer and should receive special attention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15112","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T15:36:52Z","timestamp":1744040212000},"page":"1181-1189","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Self\u2010collected vaginal <scp>HPV<\/scp> samples for long\u2010term non\u2010attendees in the Swedish organized cervical cancer screening program"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9559-3379","authenticated-orcid":false,"given":"Avalon","family":"Sundqvist","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital and Lund University  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4206-7337","authenticated-orcid":false,"given":"Caroline","family":"Hellsten","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital and Lund University  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bj\u00f6rn","family":"Strander","sequence":"additional","affiliation":[{"name":"Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magnus","family":"Lindh","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Institute of Biomedicine, Sahlgrenska Academy  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christer","family":"Borgfeldt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"World Health Organization (WHO).Global strategy to accelerate the elimination of cervical cancer as a public health problem. 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