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Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated
Marc Arbyn1, Sara B Smith2, Sarah Temin3
1Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, J Wytsmanstreet 14, B1050 Brussels, Belgium marc.arbyn@sciensano.be.
BMJ (Clinical Research Ed.)
|December 7, 2018
Summary
High-risk human papillomavirus (hrHPV) testing on self samples is accurate for detecting cervical cancer precursors when using polymerase chain reaction assays. Self-sampling kits effectively reach underscreened women, but pilot studies are crucial before widespread implementation.
Area of Science:
- Gynecologic Oncology
- Public Health
- Molecular Diagnostics
Background:
- Cervical cancer screening aims to detect precancerous lesions using high-risk human papillomavirus (hrHPV) testing.
- Self-sampling strategies are being explored to improve screening participation, particularly among underscreened populations.
- Evaluating the diagnostic accuracy of hrHPV assays on self-collected samples is crucial for clinical implementation.
Purpose of the Study:
- To assess the diagnostic accuracy of hrHPV assays performed on self-collected samples compared to clinician-collected samples.
- To determine the effectiveness of various self-sampling strategies in increasing participation among underscreened women.
Main Methods:
- An updated meta-analysis of accuracy studies and participation trials was conducted.
- Included studies compared hrHPV assay performance on self vs. clinician samples for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+).
- Participation review analyzed strategies for engaging underscreened women using self-sampling kits.
Main Results:
- Polymerase chain reaction-based hrHPV assays showed similar sensitivity and specificity on self samples versus clinician samples for detecting CIN2+ or CIN3+.
- Signal amplification-based hrHPV assays demonstrated lower sensitivity on self samples.
- Mailing self-sampling kits directly to women's homes significantly increased participation rates compared to invitations or reminders.
Conclusions:
- hrHPV testing on self samples using polymerase chain reaction assays is a viable and accurate alternative to clinician sampling for cervical cancer screening.
- Proactive distribution of self-sampling kits is an effective strategy for engaging underscreened women in screening programs.
- Careful planning and pilot testing are recommended before large-scale implementation of self-sampling strategies due to potential variability in response rates.
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