Cervical cancer screening: Is self-sampling the answer?

Abstract

Objective: To evaluate the performance of self and clinician collected samples for high-risk human papilloma virus (hr HPV) DNA detection and to assess the acceptance and attitude of women towards self-collection.

Methods: This was a prospective single blind study done in 396 women (30-65 years) attending the gynecology outpatient department (OPD). Cervical swabs were collected in duplicate (self and clinician) in transport medium and stored at 4°C until further processing. A cervical smear was also collected at the same time. High risk HPV DNA was tested using real-time polymerase chain reaction (PCR). The samples positive for HPV DNA in any of the samples either self or clinician underwent a colposcpy guided biopsy.

Results: A total of 396 women underwent screening. A total of 8% women complained of post coital bleeding. Cervical smear was inadequate in 15% and atypical squamous cells of undetermined significance (ASCUS) and above was reported in 3.7% samples. Overall agreement between self and clinician sampled HPV (C-HPV) was 91.4% with Kappa unadjusted being 43.4% (95% CI: 35.8-51.1). Overall agreement between C-HPV and cervical smear was 79.5% with Kappa unadjusted of 19.2% (95% CI: 12.8-25.5). Overall agreement between self and cervical smear was 80.0% with Kappa unadjusted value of 21.7% (95% CI: 14.7 to 28.7). A total of 23 women underwent biopsy of which 19 were diagnosed with cervical intraepithelial neoplasia-1 (CIN-1) and above with a positive predictivity rate of 100% with either screening result being positive.

Conclusion: HPV DNA self-sampling can be a major breakthrough in breaking the shackles of underutilization of cervical cancer screening and thus decrease the morbidity and mortality of cervical cancer.