Abstract
BackgroundInterventions to reach women who do not participate regularly in screening may reduce the risk of cervical cancer. Self-collection of a vaginal specimen has been shown to increase participation. The relative clinical accuracy of human papillomavirus (HPV) testing on first-void urine (with Colli-Pee) and on vaginal self-samples versus on cervical clinician-collected samples is being investigated in the VALHUDES trial. The current study assesses attitudes and experiences regarding self-sampling among women enrolled in VALHUDES.MethodsQuestionnaires from 515 women (age 25–64 years [N = 498]; < 25 [N = 10], age ≥ 65 [N = 3], enrolled between December 2017 - January 2020) referred to colposcopy because of previous cervical abnormalities and enrolled in VALHUDES (NCT03064087) were analysed.ResultsOf the 515 participants, nearly all women confirmed that self-sampling may help in reaching under-screened women (93%). Nevertheless, 44% of the participants stated before starting collection that a clinician-collected sample is more effective than a self-collected sample. After self-sampling, the large majority of women (> 95%) declared that instructions for self-collection were clear, that collection was easy, and that they were confident about having performed the procedure correctly, for both urine and vaginal collection. However, a proportion of women found self-sampling unpleasant (9.5% [49/515] for urine collection; 18.6% [96/515] and 15.5% [80/515] for vaginal sampling with cotton swabs or plastic brushes, respectively). For their next screening round, 57% would prefer self-sampling whereas 41% opted for collection by a clinician. Among women preferring self-sampling, 53% would choose for urine collection, 38% for vaginal self-collection and 9% had no preference. Age did not modify preferences.ConclusionWe conclude that both urine and vaginal self-sampling are well accepted by women, with a preference for urine sampling. Although the large majority of women are confident in their ability to perform self-sampling, four to five over ten women preferred specimen collection by a clinician.Trial registrationThe study VALHUDES was registered in ClinicalTrials.gov (identifier: NCT03064087).
Highlights
Interventions to reach women who do not participate regularly in screening may reduce the risk of cervical cancer
De Pauw et al Archives of Public Health (2021) 79:155. We conclude that both urine and vaginal self-sampling are well accepted by women, with a preference for urine sampling
Five Belgian colposcopy clinics (University Hospital of Antwerp (UZA), Brussels (UZ Brussels), Ghent University Hospital (Ghent) (UZ Ghent), Liège University Hospital (Liège) (CHU de Liège), and the General Regional Hospital Heilig Hart Tienen (RZ Tienen)) had to enrol at least 500 consenting eligible women between the age of 25 and 64, who were referred for colposcopy because of previous cervical abnormalities (Atypical Squamous Cell where a High-grade squamous lesion cannot be excluded [ASC-H] or worse squamous cervical abnormalities, Atypical Glandular Cells [Atypical glandular cells (AGC)], repeated low-grade abnormalities or human papillomavirus (HPV)+ Atypical Squamous cells of Undetermined Significance [Atypical squamous cells of undetermined significance (ASC-US)])
Summary
Interventions to reach women who do not participate regularly in screening may reduce the risk of cervical cancer. Self-collection of a vaginal specimen has been shown to increase participation. The relative clinical accuracy of human papillomavirus (HPV) testing on first-void urine (with Colli-Pee) and on vaginal self-samples versus on cervical clinician-collected samples is being investigated in the VALHUDES trial. Randomised population-based controlled trials have demonstrated that HPV-based CC screening offers higher protection against incident cervical precancer and cancer compared to cytology-based screening [7, 8]. Randomised participation trials have shown that the offer of a self-sampling kit generates higher response rates than conventional invitations to have a screening specimen taken by a clinician [11]. Collection of urine has been indicated as less embarrassing than taking a cervico-vaginal selfsample [13]
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