@article{3078015,
    title = "Implementation of HPV-based Cervical Cancer Screening Combined with Self-sampling Using a Midwifery Network across Rural Greece: The Grecoself study",
    author = "Agorastos, T. and Chatzistamatiou, K. and Tsertanidou, A. and Mouchtaropoulou, E. and Pasentsis, K. and Kitsou, A. and Moysiadis, T. and Moschaki, V. and Skenderi, A. and Katsiki, E. and Aggelidou, S. and Venizelos, I. and Ntoula, M. and Daponte, A. and Vanakara, P. and Garas, A. and Stefos, T. and Vrekoussis, T. and Lymberis, V. and Kontomanolis, E.N. and Makrigiannakis, A. and Manidakis, G. and Deligeoroglou, E. and Panoskaltsis, T. and Decavalas, G.O. and Michail, G. and Kalogiannidis, I. and Koukoulis, G. and Zempili, P. and Halatsi, D. and Truva, T. and Piha, V. and Agelena, G. and Chronopoulou, A. and Vaitsi, V. and Chatzaki, E. and Paschopoulos, M. and Adonakis, G. and Kaufmann, A.M. and Hadzidimitriou, A. and Stamatopoulos, K.",
    journal = "Cancer Prevention Research",
    year = "2019",
    volume = "12",
    number = "10",
    pages = "701-710",
    publisher = "American Association for Cancer Research Inc.",
    issn = "1940-6207, 1940-6215",
    doi = "10.1158/1940-6207.CAPR-19-0192",
    keywords = "adult;  age distribution;  aged;  Article;  cancer grading;  cancer risk;  cancer screening;  cancer surgery;  chemoradiotherapy;  cohort analysis;  colposcopy;  cross-sectional study;  DNA screening;  female;  genotype;  Greece;  health care planning;  high risk population;  histopathology;  human;  Human papillomavirus type 16;  Human papillomavirus type 18;  human tissue;  hysterectomy;  major clinical study;  middle aged;  midwife;  nonhuman;  observational study;  Papanicolaou test;  patient compliance;  patient referral;  predictive value;  prevalence;  priority journal;  questionnaire;  risk assessment;  rural area;  sampling;  self sampling;  uterine cervix cancer;  uterine cervix carcinoma;  uterine cervix carcinoma in situ;  virus detection;  Wart virus;  adolescent;  community care;  complication;  early cancer diagnosis;  genetics;  Human papillomavirus DNA test;  isolation and purification;  mass screening;  nurse attitude;  nurse midwife;  organization and management;  Papillomaviridae;  papillomavirus infection;  pathology;  procedures;  rural population;  self evaluation;  specimen handling;  uterine cervix carcinoma in situ;  uterine cervix tumor;  vagina smear;  young adult, virus DNA, Adolescent;  Adult;  Aged;  Cervical Intraepithelial Neoplasia;  Colposcopy;  Community Networks;  Cross-Sectional Studies;  Diagnostic Self Evaluation;  DNA, Viral;  Early Detection of Cancer;  Female;  Greece;  Human Papillomavirus DNA Tests;  Humans;  Implementation Science;  Mass Screening;  Middle Aged;  Midwifery;  Nurse Midwives;  Nurse's Role;  Papillomaviridae;  Papillomavirus Infections;  Rural Population;  Specimen Handling;  Uterine Cervical Neoplasms;  Vaginal Smears;  Young Adult",
    abstract = "Self-sampling for human papillomavirus (HPV) testing is an alternative to physician sampling particularly for cervical cancer screening nonattenders. 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 years to 5.1% for women aged 50-60 years. Positive predictive value for hrHPV testing and for HPV16/18 genotyping ranged from 5.0% to 11.6% and from 11.8% to 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 promising method for cervical cancer secondary prevention. ©2019 American Association for Cancer Research."
}