Implementation of HPV-based cervical cancer screening combined with self-sampling using a midwifery network across rural Greece. The GRECOSELF study.

Self-sampling for human papillomavirus (HPV) testing is an alternative to physician-sampling particularly for cervical cancer screening non-attenders. The GRECOSELF study is a nationwide observational cross-sectional study aiming to suggest a way to implement HPV-DNA testing in conjunction with self-sampling for cervical cancer screening in Greece, utilizing a midwifery network. Women residing in remote areas of Greece were approached by midwives, of a nationwide network, and were provided with a self-collection kit (dry swab) for cervicovaginal sampling and asked to answer a questionnaire about their cervical cancer screening history. Each sample was tested for high-risk (hr) HPV with the cobas® HPV test. HrHPV positive women were referred to undergo colposcopy and, if needed, treatment according to colposcopy/biopsy results. Between May 2016 and November 2018, 13,111 women were recruited. Of these, 12,787 women gave valid answers in the study questionnaire and had valid HPV-DNA results; hrHPV prevalence was 8.3%; high-grade cervical/vaginal disease or cancer prevalence was 0.6%. HrHPV positivity rate decreased with age from 20.7% for women aged 25-29 to 5.1% for women 50-60. Positive predictive value for hrHPV testing and for HPV16/18 genotyping ranged from 5.0-11.6% and from 11.8-27.0%, respectively, in different age groups. Compliance to colposcopy referral rate ranged from 68.6% (for women 25-29) to 76.3% (for women 40-49). For women residing in remote areas of Greece, the detection of hrHPV DNA with the cobas® HPV test on self-collected cervicovaginal samples using dry cotton swabs which are, provided by visiting midwives, is a more promising method than cytology-based opportunistic screening.