Cervical cancer self-sampling tests could improve access.

Abstract

Home-based self-sampling tests for high-risk human papillomavirus (hrHPV) infection may be one way to increase access to cervical cancer screening among women who do not attend traditional screening appointments or who live in developing countries that lack formal screening programs according to a recent study in The BMJ.1 According to the researchers, who represent health organizations and medical facilities in Belgium, the United States, and Australia, not only does evidence suggest that hrHPV testing is more effective in protecting against cervical precancer and cancer than screening by cytology, but it seems to offer one other advantage: “It can be done on vaginal samples collected by the patient, whereas cytology on self-samples shows poor accuracy.” To assess how well self-sampling of hrHPV testing performed and whether it could improve cervical cancer prevention in underscreened populations, they completed 2 systematic reviews of published trial results. the first included 56 studies that assessed the accuracy of hrHPV testing of samples collected by women themselves in comparison with those collected by a clinician. the second involved 25 trials that compared the effect of providing self-sampling kits with making screening appointments for underscreened women, including those who had missed previous appointments. In the first review, researchers found that hrHPV tests based on polymerase chain reaction detected cervical precancers (grade 2 or higher cervical intraepithelial neoplasia and grade 3 or higher cervical intraepithelial neoplasia) equally in samples taken by women themselves and those taken by a clinician. However, tests using a process known as signal amplification were not as effective when women, rather than clinicians, collected the samples. Also, for both types of hrHPV tests, the self-samples had a slightly higher number of false-positives compared to those taken by a clinician. Results of the second analysis indicated that women in the study who were sent self-sample kits were more than twice as likely to respond and send a sample as they were to attend an appointment based on receiving an invitation or reminder letter. Furthermore, when women in developing countries without formal screening programs were offered self-sampling test kits during a home visit, more than 80% accepted them. Although cervical cancer rates have declined in many developed countries in Europe and North America as well as Australia and New Zealand, rates remain high in Eastern Europe and less developed countries in Latin America and Africa that have low-quality or no screening programs. The authors recommend that a polymerase chain reaction-based HPV test be used where resources allow. Where they do not, the less expensive signal-based HPV test may still provide benefits, they say.