Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis

Area of Science:

• Gynecology
• Oncology
• Public Health

Background:

• Cervical cancer screening uptake remains suboptimal globally.
• Human papillomavirus (HPV) self-sampling offers a potential strategy to improve early detection and reduce the burden of cervical cancer.
• This systematic review and meta-analysis informs World Health Organization (WHO) self-care guidelines.

Approach:

• A systematic review and meta-analysis of 33 studies (29 RCTs, 4 observational studies) involving 369,017 participants.
• Searched major databases (PubMed, CINAHL, LILACS, Embase) through October 2018.
• Assessed risk of bias using established tools and conducted random-effects meta-analyses to pool relative risks (RR).

Key Points:

• HPV self-sampling significantly increased cervical cancer screening uptake (RR: 2.13, 95% CI 1.89 to 2.40) compared to standard of care.
• Uptake varied by kit dissemination method: mailed (RR: 2.27), door-to-door (RR: 2.37), and on-demand (RR: 1.28).
• No statistically significant difference was found in linkage to clinical assessment/treatment (RR: 1.12).

Conclusions:

• HPV self-sampling demonstrates a strong potential to enhance cervical cancer screening uptake, particularly in high-income countries.
• Evidence suggests a marginal effect on linkage to clinical assessment and treatment.
• Further research is needed on screening frequency and social harms/adverse events associated with HPV self-sampling.