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Human papillomavirus detection for cervical cancer prevention with polymerase chain reaction in self-collected
Felipe R Lorenzato1, Albert Singer, Linda Ho
1Department of Obstetrics and Gynecology, Instituto Materno Infantil de Pernambuco, Brazil. lorenzato@br.inter.net
Objective:
We studied the usefulness of self-sampling in cervical cancer prevention.
Study Design:
A cross-sectional study was undertaken at screening services in Recife (Brazil); 253 women aged 16 to 88 years were included. Participants were randomly selected from a high-risk population for cervical neoplasia. All participants collected a self-sample with a cotton-tipped swab by rotating it against the vaginal epithelium and, possibly, the cervix. Physician-collected samples from the ectocervix and endocervix, respectively, with an Ayre's spatula and a Cytobrush endocervical brush (Medscand) were followed by thorough colposcopy. Human papillomaviruses were detected by consensus polymerase chain reaction and typed by restriction fragment length polymorphism.
Results:
The difference among human papillomavirus results in samples that were self-collected versus physician collected was significant (P <.03). The agreements were poor among patients with cervical intraepithelial neoplasia (CIN) grade 3 (kappa <0.29) and cervical cancer (kappa < 0.10). Self-sampling missed 50% more cancers than did physician sampling (P =.04).
Conclusion:
Self-sampling with a cotton-tipped swab for human papillomavirus detection is not a safe method for the collection of samples that are aimed at primary cervical cancer screening.