Implementation of a Cervical Cancer Screening Strategy Using HPV Self-Sampling for Women Living in Rural Areas

Abstract

Background: The implementation of population screening for cervical lesions in rural areas has been particularly challenging for a variety of reasons, including geographic isolation, limited access to medical care, lack of awareness of cancer risks, lower education levels, and embarrassment about having the clinical examination. Methods: This study was designed to evaluate the use of self-sampling for human papillomavirus (HPV) screening in the rural communities served by our hospital. To develop the study group, we trained a local police officer who was already interacting with the rural community to explain cancer risks and the ease of self-sampling to the women. Results: We identified a study group of 386 women, of whom 369 (95.6%) agreed to participate in the study. To test for high-risk HPV, we performed the Cobas PCR test, and of 340 valid samples, 45 (12.2%) were positive for at least 1 of the high-risk HPV subtypes. All positively tested women were referred for colposcopy and Papanicolaou testing. The follow-up biopsies showed that 40% had low-grade intraepithelial neoplasia (CIN1), 6.6% had high-grade intraepithelial neoplasia (CIN2/3), and 4.4% had squamous cell carcinoma. Conclusions: Self-collection for HPV testing by women living in isolated communities is highly efficient and has potential for cost-effective screening by taking advantage of existing support networks, such as the local police service.