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Ahannach S, Van Hoyweghen I, Verhoeven V, Lebeer S. Citizen science as an instrument for women's health research. Nat Med 2024; 30:3445-3454. [PMID: 39578585 DOI: 10.1038/s41591-024-03371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 10/22/2024] [Indexed: 11/24/2024]
Abstract
Women's health research is receiving increasing attention globally, but considerable knowledge gaps remain. Across many fields of research, active involvement of citizens in science has emerged as a promising strategy to help align scientific research with societal needs. Citizen science offers researchers the opportunity for large-scale sampling and data acquisition while engaging the public in a co-creative approach that solicits their input on study aims, research design, data gathering and analysis. Here, we argue that citizen science has the potential to generate new data and insights that advance women's health. Based on our experience with the international Isala project, which used a citizen-science approach to study the female microbiome and its influence on health, we address key challenges and lessons for generating a holistic, community-centered approach to women's health research. We advocate for interdisciplinary collaborations to fully leverage citizen science in women's health toward a more inclusive research landscape that amplifies underrepresented voices, challenges taboos around intimate health topics and prioritizes women's involvement in shaping health research agendas.
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Affiliation(s)
- Sarah Ahannach
- Laboratory of Applied Microbiology and Biotechnology, Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
- U-MaMi Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Ine Van Hoyweghen
- Life Sciences and Society Lab, Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Veronique Verhoeven
- U-MaMi Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Sarah Lebeer
- Laboratory of Applied Microbiology and Biotechnology, Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium.
- U-MaMi Centre of Excellence, University of Antwerp, Antwerp, Belgium.
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2
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Beaverson S, Cyrus JW, Huffstetler AN. Concordance of Primary Human Papillomavirus Testing Among Clinicians and Patients: A Systematic Review. J Womens Health (Larchmt) 2023; 32:1062-1072. [PMID: 37582276 PMCID: PMC10623466 DOI: 10.1089/jwh.2023.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Objective: Primary high risk human papilloma virus (hrHPV) testing is recommended as first-line screening for cervical cancer. Testing involves either a clinician-collected or a self-collected cervicovaginal swab. This study examines concordance between methods of collection of primary HPV testing. Methods: Ovid MEDLINE, Ovid Embase, and Cochrane were searched for relevant studies on self-collected and clinician-collected primary HPV testing published before December 31, 2022. English-language studies for primary HPV testing of average-risk patients were included. Studies conducted in screening settings rather than colposcopy clinics, that used standard devices for HPV collection, and that directly compared methods of collection were included. Outcomes were concordance and kappa between paired samples, and rate of HPV detection in self-collected and clinician-collected samples. Results: A total of 2381 studies were screened, of which 228 were included for full-text evaluation. Thirty-six studies, including 23,328 individuals screened, met the inclusion criteria. The rate of HPV detection ranged from 4.7% to 63% for self-collection and from 3.7% to 62% for clinician-collection. The concordance ranged from 78.2% to 96.9%, and kappa had substantial agreement for 26 of the 36 studies and moderate agreement for 7 of the 36 studies. Conclusions: This study directly compares clinician-collected and self-collected primary HPV screening rates. Studies were conducted in methods which are widely reproducible in the primary care setting. Primary HPV self-collection is a reliable and accurate method for cervical cancer screening.
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Affiliation(s)
- Sarah Beaverson
- School of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - John W. Cyrus
- Health Sciences Library, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alison N. Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
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Sangrajrang S, Pitakkarnkul S, Muwonge R, Ploysawang P, Pangmuang P, Seeda K, Basu P. Agreement between Self- and Physician‑Sampling for Detection of High‑Risk Human Papillomavirus Infections in Women Attending Cervical Screening at National Cancer Institute, Thailand. Asian Pac J Cancer Prev 2023; 24:2615-2619. [PMID: 37642046 PMCID: PMC10685204 DOI: 10.31557/apjcp.2023.24.8.2615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND We determined testing of self-sampling vagina swabs for Human Papilloma Virus (HPV) can be used to screen for cervical disease in outpatient clinics. METHODS In this study, women attending cervical cancer screening clinic and gynecology clinic of the National Cancer Institute were invited to take a vaginal self-sampling and physician-collected cervical sampling. RESULTS Of 268 participants, 20 (7.5%) were HPV-positive on the physician-collected samples. Among these screen-positive women, only two (0.7%) had HPV 18 and/or 45 and none had HPV 16 infections. For the self-collected samples, 4 participants had invalid HPV test results. Of the remaining 264 women with valid test results on self-collected samples, 29 (11.0 %) were HPV-positive, of whom, two (0.8%) were infected with HPV 16 and one (0.4%) with HPV 18 and/or 45 infections. The agreement between self-sampling and physician-sampling HPV test results (when two HPV results categories were considered) was 92. 8% with a moderate Kappa value of 0.57. CONCLUSION Overall, self-sampling seems to be a reliable alternative to health-provider collection. However, instructions on proper procedures for sample collection to the women are important step before general roll out.
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Affiliation(s)
- Suleeporn Sangrajrang
- National Cancer Institute, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
| | - Supakorn Pitakkarnkul
- Division of Gynecologic Oncology, National Cancer Institute, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
| | - Richard Muwonge
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
| | - Pattama Ploysawang
- National Cancer Institute, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
| | - Parinda Pangmuang
- National Cancer Institute, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
| | - Kanda Seeda
- National Cancer Institute, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
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Jaya ZN, Mapanga W, van Niekerk B, Dlangalala T, Kgarosi K, Dzobo M, Mulqueeny D, Mashamba-Thompson TP. Mapping Evidence of Self-Sampling to Diagnose Sexually Transmitted Infections in Women: A Scoping Review. Diagnostics (Basel) 2022; 12:1803. [PMID: 35892514 PMCID: PMC9331851 DOI: 10.3390/diagnostics12081803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a major global healthcare burden, disproportionately affecting women. Self-sampling interventions for diagnostic purposes have the potential to improve STI healthcare management and expand STI services. However, there is currently no published evidence of the global use of self-sampling interventions to diagnose STIs in women. The main aim of this scoping review was to map evidence on the use of self-sampling interventions to diagnose STIs in women. METHODOLOGY The methodology of this scoping review was guided by Arksey and O'Malley and Levac. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Medline (EBSCO), ProQuest, and Cochrane. For grey literature, a search was conducted in Open Grey, World Health Organization, Google, and conference proceedings and dissertations. All search results were screened and assessed for eligibility. Thereafter data from eligible studies was extracted and analysed. The quality of these studies was appraised using the Mixed Methods Appraisal Tool 2018 version. RESULTS A total of 770 articles were retrieved from databases and grey literature sources. A total of 44 studies were eligible for data extraction following title, abstract and full-text screening. Of the included studies, 63% presented evidence of research conducted in high-income countries and 37% presented evidence in low- and middle-income countries. Studies presented evidence on the following: feasibility of self-sampling in remote areas; acceptance and ease of use of self-sampling interventions; types of self-sampled specimens; pooled samples for diagnosing STIs; laboratory diagnostic assays for STI using self-sampled specimens; and self-testing of self-sampled specimens. CONCLUSIONS Self-sampling interventions are feasible and easy to use and, therefore, can improve STI management and treatment in women across various age groups and various access levels to good-quality healthcare. Despite this, there is a lack of evidence of self-sampling interventions designed according to user preferences. We recommend studies to collaborate with women to co-develop user-friendly self-sampling interventions to diagnose STIs in women.
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Affiliation(s)
- Ziningi N. Jaya
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (W.M.); (T.D.); (M.D.)
- Department of Biomedical Science, Faculty of Natural Science, Mangosuthu University of Technology, Umlazi 4031, South Africa
| | - Witness Mapanga
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (W.M.); (T.D.); (M.D.)
| | - Brian van Niekerk
- Department of Plant and Soil Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0002, South Africa;
| | - Thobeka Dlangalala
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (W.M.); (T.D.); (M.D.)
| | - Kabelo Kgarosi
- Department of Library Services, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa;
| | - Mathias Dzobo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa; (W.M.); (T.D.); (M.D.)
| | - Delarise Mulqueeny
- Department of Social Work, Faculty of Arts, University of Zululand, Richards Bay 3900, South Africa;
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Gamelin R, Hébert M, Tratt E, Brassard P. Ethnographic study of the barriers and facilitators to implementing human papillomavirus (HPV) self-sampling as a primary screening strategy for cervical cancer among Inuit women of Nunavik, Northern Quebec. Int J Circumpolar Health 2022; 81:2032930. [PMID: 35166191 PMCID: PMC8856049 DOI: 10.1080/22423982.2022.2032930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The rate of cervical cancer among Canadian Inuit women is higher than the national average. To date, early detection remains the best strategy for reducing the incidence of cervical cancer and its consequences. Thus, the aim of this study was to explore the barriers and facilitators in implementing human papillomavirus (HPV) self-sampling as a primary screening strategy for cervical cancer among Inuit women of Nunavik in Northern Quebec. A focused ethnographic approach was adopted. Inuit women of Nunavik participated in individual or group interviews during which a semi-structured interview guide was used to determine their perceptions of the barriers and facilitators to implementing HPV self-sampling as a primary screening strategy for cervical cancer. The data were analysed based on Paillé’s grounded theory of qualitative analysis. Twenty-eight Inuit women participated in this study. Analysis revealed five subcategories of facilitators and four barriers. Inuit women may embrace the self-sampling method. Importantly, in order to be effective, these strategies must be culturally sensitive and adapted to women’s preferences so as to increase sustainability. The results of this study provide the means for integrating the perspectives of Inuit women in implementing HPV self-sampling as a primary screening strategy for cervical cancer in Nunavik. Consideration of these facilitators and barriers might maximise the chance of success and optimise the screening participation rate.
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Affiliation(s)
- Rachel Gamelin
- Nursing Department, Université Du Québec À Trois-Rivières, Trois-Rivières, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Maude Hébert
- Nursing Department, Université Du Québec À Trois-Rivières, Trois-Rivières, Canada
| | - Elyse Tratt
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Paul Brassard
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
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Vahabi M, Lofters AK, Mishra G, Pimple S, Wong JPH. Family-Centered Sexual Health Intervention to Promote Cervical Cancer Screening Uptake Among Low-income Rural Women in India: A Community-Based Mixed-Method Pilot study (Preprint). JMIR Res Protoc 2021; 11:e35093. [PMID: 36074549 PMCID: PMC9501679 DOI: 10.2196/35093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/08/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (formerly known as Ryerson University), Toronto, ON, Canada
| | | | | | | | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (formerly known as Ryerson University), Toronto, ON, Canada
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Pantano NDP, Fregnani JH, Resende JC, Zeferino LC, Fonseca BDO, Antoniazzi M, Oliveira CMD, Sant'ana GDR, Longatto-Filho A. Evaluation of human papillomavirus self-collection offered by community health workers at home visits among under-screened women in Brazil. J Med Screen 2020; 28:163-168. [PMID: 32703059 DOI: 10.1177/0969141320941056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore the acceptability of high-risk human papillomavirus self-testing, involving community health workers, for never/under-screened Brazilian women. Cervical cancer is the most common cause of cancer-related death among adult women in a large number of low-income and lower-middle-income countries, where it remains a major public health problem. High-risk human papillomavirus persistence is required for the development of cervical neoplasia. METHODS The target population was all women aged 30+ from the list of families available in healthcare centre data, who had never been screened or were not screened in the previous 3 years (under-screened women), and who were living in the 17 cities included in this study. RESULTS Of the 377 women included, 16.9% (n = 64) had never had a pap smear. Of all samples included in the study, 97.1% (n = 366) were considered adequate for evaluation, as 2.9% (n = 11) were considered invalid for all high-risk human papillomavirus types. Analysing these 366 samples, 9.6% (n = 35) of the women were infected by at least one high-risk human papillomavirus type and 90.4% (n = 331) had no infection with any high-risk type of the virus. CONCLUSIONS Vaginal self-sampling is an adequate strategy to improve the effectiveness of the cervical cancer program by increasing screening in a high-risk group.
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Affiliation(s)
| | - José H Fregnani
- Research and Teaching Institute, Barretos Cancer Hospital, Barretos, Brazil.,A.C.Camargo Cancer Center, Liberdade, Brazil
| | - Júlio Cp Resende
- Prevention Cancer Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Luiz C Zeferino
- School of Medical Sciences, Women's Hospital CAISM, Unicamp, Campinas, Brazil
| | | | - Márcio Antoniazzi
- Prevention Cancer Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cristina M de Oliveira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, 56059University of Minho, Braga, Portugal.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Adhemar Longatto-Filho
- Research and Teaching Institute, Barretos Cancer Hospital, Barretos, Brazil.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, 56059University of Minho, Braga, Portugal.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Laboratory of Medical Investigation (LIM-14), School of Medicine, University of Sao Paulo, São Paulo, Brazil
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Acceptability of Women Self-Sampling versus Clinician-Collected Samples for HPV DNA Testing: A Systematic Review. J Low Genit Tract Dis 2019; 23:193-199. [PMID: 30933030 DOI: 10.1097/lgt.0000000000000476] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Female self-sampling for human papillomavirus (HPV) DNA testing is an alternative screening method that can potentially increase cervical cancer screening coverage. This review addresses the acceptability of HPV DNA testing using self-sampling compared with conventional clinician-collected sampling. Barriers to and others factors associated with acceptability of either method were also examined. METHODS The following electronic resources were searched: Medline @EBSCOHOST(Medline), Embase, PubMed, and CINAHL databases. Manual searches were also conducted. The main outcome of interest was the acceptability of HPV DNA testing by self-sampling in comparison with clinician-collected sampling. RESULTS In total, 23 articles were included in this systematic review. The majority (19 studies) were quantitative intervention studies and 4 studies were qualitative observational studies. Eleven studies reported a preference for self-sampling by women compared with clinician-collected sampling (64.7%-93%). The remaining studies found that women preferred clinician-collected sampling because mainly of respondents' lack of confidence in their ability to complete self-sampling correctly. In most articles reviewed, the studied associated factors, such as demographic factors (age, marital status, and ethnicity), socioeconomic factors (income, education level), reproductive factors (condom use, number of children, current use of contraception, and number of partners), and habits (smoking status) were not found to be significantly associated with preference. CONCLUSIONS Both methods of sampling were found to be acceptable to women. Self-sampling is cost-effective and could increase the screening coverage among underscreened populations. However, more information about the quality, reliability, and accuracy of self-sampling is needed to increase women's confidence about using to this method.
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Affiliation(s)
- George Yizhou Tang
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jay Parekh
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Can Human Papillomavirus DNA Self-sampling be an Acceptable and Reliable Option for Cervical Cancer Screening in Female Sex Workers? Cancer Nurs 2018; 41:45-52. [PMID: 28114260 DOI: 10.1097/ncc.0000000000000462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The causal relation between human papillomavirus (HPV) and cervical cancer has enabled HPV self-sampling to be envisaged as a possible screening method. OBJECTIVES The aim of this study is to explore the acceptability and reliability of HPV DNA self-sampling as an alternative option for cervical screening among female sex workers. METHODS Sixty-eight participants carried out self-sampling for HPV testing, gave a clinician-obtained sample for HPV testing, and a Papanicolaou test. After the samplings, the participants were questioned on the acceptability of the tests. RESULTS Most participants (65.6%) preferred to adopt HPV DNA self-sampling in the future; in particular, those without previous experience of Papanicolaou tests marginally significantly preferred self-sampling (86.7%, P = .055). The overall crude agreement in HPV detection rates between clinician and HPV DNA self-sampling was 85.3% (58/68), with a κ of 0.69 (95% confidence interval, 0.51-0.87). The sensitivity and specificity of self-collected samples were 66.7% and 66.1%, respectively, and the positive and negative predicted values were 24.0% and 92.5%, respectively. The prevalence of HPV was slightly higher in self-collected samples (39.7%, 27/68) than in clinician-collected samples (36.8%, 25/68). The participants expressed positive attitudes toward self-sampling but were less confident in their skills of self-sampling compared with clinicians (70.6% versus 91.2%). CONCLUSIONS The findings showed that self-sampling could be incorporated into current cervical cancer screening approaches. IMPLICATIONS FOR PRACTICE Self-sampling could potentially increase compliance to cervical cancer screening and thus reduce the morbidity and mortality from cervical cancer. Further research and education on self-sampling will be required for women of diverse backgrounds.
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Ajenifuja OK, Ikeri NZ, Adeteye OV, Banjo AA. Comparison between self sampling and provider collected samples for Human Papillomavirus (HPV) Deoxyribonucleic acid (DNA) testing in a Nigerian facility. Pan Afr Med J 2018; 30:110. [PMID: 30364362 PMCID: PMC6195243 DOI: 10.11604/pamj.2018.30.110.14321] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction The multiple visits required for an effective Pap smear screening program is difficult to replicate in many developing countries. This precludes early diagnosis and care for patients with cervical cancer and contributes to its high mortality in these countries. HPV screening has higher specificity and high negative predictive value and has the advantage that materials can be self-collected, which permits the screening of women who for various cultural and religious reasons would be reluctant to come to the clinic to expose themselves for screening. The aim of the study was to assess the degree of agreement between self sampling for HPV DNA with samples collected by a health provider. Methods Each respondent selected from women presenting for cervical cancer screening underwent both self- and provider sampling for HPV DNA testing using Hybribio GenoArray. Results Of the 194 women screened, 12 (6.2%) and 19 (9.8%) had HPV on self sampling and provider col-lected samples respectively. The commonest HPV type seen using both techniques was HPV 58 (2.6%). Multiple HPV genotypes were seen in 1 (0.5%) and 5 cases (2.6%) of provider and self-collected samples respectively. The high risk-HPV detection rate was 7.2% when self sampled and 6.8% when sampled by the provider. There was moderate correlation between both sampling techniques (κ = 0.47, 95% CI: 21.3 - 72.3%, P < 0.05). Conclusion Our study shows moderate correlation between both sampling techniques. Larger multicentre studies will be needed to provide results generalisable to the Nigerian population. Keywords: Pap smear, HPV screening, cervical cancer, sample collection, self-sampling, provider collected, PCR, HPV DNA, Ile-Ife Nigeria.
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Affiliation(s)
| | | | | | - Adekunbiola Aina Banjo
- Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital.,Department of Anatomic and Molecular Pathology, College of Medicine University of Lagos
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Vahabi M, Lofters A. HPV self-sampling: A promising approach to reduce cervical cancer screening disparities in Canada. ACTA ACUST UNITED AC 2018; 25:13-18. [PMID: 29507479 DOI: 10.3747/co.25.3845] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Human papillomavirus (HPV) is the primary cause of cervical, anal, and other genital cancers, which are preventable through screening and early treatment. [...]
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Affiliation(s)
- M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Co- Director, Ryerson Centre for Global Health and Health Equity, Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON
| | - A Lofters
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, and Department of Family and Community Medicine, University of Toronto, Toronto, ON
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Phoolcharoen N, Kantathavorn N, Krisorakun W, Sricharunrat T, Teerayathanakul N, Taepisitpong C, Sornsamdang G, Krongthong W, Saeloo S. Agreement of self- and physician-collected samples for detection of high-risk human papillomavirus infections in women attending a colposcopy clinic in Thailand. BMC Res Notes 2018; 11:136. [PMID: 29458440 PMCID: PMC5819229 DOI: 10.1186/s13104-018-3241-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/09/2018] [Indexed: 11/10/2022] Open
Abstract
Objective To study the concordance between vaginal self- and endocervical physician-collected high-risk (hr) HPV testing in Thai women who attended a colposcopy clinic. Vaginal samples were obtained by self-sampling with a dry brush before endocervical samples were obtained by physicians. Both specimens were analyzed for hrHPV by Cobas4800 HPV test. Results Of the 247 pairs of samples, overall hrHPV prevalence from self- and physician-collected samples was 41.3 and 36.0%, respectively. The overall agreement between the methods was 74.5% with κ 0.46 (P < 0.001). Our study revealed moderate agreement between self- and physician-collected methods for hrHPV testing.
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Affiliation(s)
- Natacha Phoolcharoen
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand. .,Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
| | - Nuttavut Kantathavorn
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wasanai Krisorakun
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Thaniya Sricharunrat
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Narongchai Teerayathanakul
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chantanee Taepisitpong
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Gaidganok Sornsamdang
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Waraphorn Krongthong
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Siriporn Saeloo
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Madzima TR, Vahabi M, Lofters A. Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:597-601. [PMID: 28807952 PMCID: PMC5555324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To provide a focused critical review of the literature on the acceptability, feasibility, and uptake of human papillomavirus (HPV) self-sampling among hard-to-reach women. QUALITY OF EVIDENCE A focused search to obtain relevant literature published in English between 1997 and 2015 was done using PubMed and EMBASE using search terms including HPV self-test or HPV self-sample or HPV kit in combination with acceptability or feasibility. Only studies that focused on never-screened or underscreened populations were included in this review. MAIN MESSAGE Human papillomavirus self-sampling was found to be highly acceptable and feasible among these hard-to-reach women across most studies. Mailing of self-sampling kits has been shown to increase participation among hard-to reach women. Some concerns remain regarding adherence to further follow-up among high-risk women with positive test results for HPV after screening. CONCLUSION There is a strong body of evidence to support the usefulness of HPV self-sampling in increasing participation of hard-to-reach women in screening programs (level I evidence). Convenience, privacy, ease of use, and, likely, cost-effectiveness of HPV self-sampling are driving forces in its emerging role in cervical cancer screening among hard-to-reach women. Key barriers to participation could be addressed by overcoming disparities in HPV-related knowledge and perceptions about cervical cancer screening.
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Affiliation(s)
- Tina R Madzima
- Diagnostic radiology resident in the Department of Medical Imaging at the University of Toronto in Ontario
| | - Mandana Vahabi
- Associate Professor at the Daphne Cockwell School of Nursing at Ryerson University and Co-Director of the Ryerson Centre for Global Health and Health Equity in Toronto
| | - Aisha Lofters
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto, a scientist at the Centre for Urban Health Solutions at St Michael's Hospital, and a staff physician for St Michael's Hospital Academic Family Health Team in Toronto.
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Evaluation of the Impact of Human Papillomavirus DNA Self-sampling on the Uptake of Cervical Cancer Screening. Cancer Nurs 2017; 39:E1-E11. [PMID: 25730587 PMCID: PMC4892762 DOI: 10.1097/ncc.0000000000000241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: The rate of uptake of the Papanicolaou (Pap) smear is generally low. Its causal relationship with human papillomavirus (HPV) DNA allows HPV DNA self-sampling to be used as an alternative screening tool for cervical cancer. Objectives: This study explored the acceptability of HPV DNA self-sampling and its impact on the rate of compliance with cervical cancer screening. Methods: A crossover randomized clinical trial was conducted in community-based clinics. Participants were allocated to 1 of the following 2 arms: arm 1: self-sampling before a Pap smear; and arm 2: a Pap smear before self-sampling. After completing the 2 screening methods, participants in each arm took part in face-to-face interviews using standardized, structured questionnaire. Results: The participants accepted both self-sampling (7.7/10) and a Pap smear (7.8/10) for cervical cancer screening. However, participants without previous experience of Pap smears or who had more than 2 sexual partners preferred self-sampling (P < .05). The participants expressed overall positive feelings toward self-sampling, and there was good agreement in HPV detection between the 2 screening methods (κ = 0.65). We estimate that the introduction of HPV DNA self-sampling could increase the future rate of uptake of cervical cancer screening by 6.5% and would entail lower costs. Conclusion: Human papillomavirus DNA self-sampling could be an alternative screening method to increase the coverage of cervical cancer screening. Implications for Practice: Human papillomavirus DNA self-sampling could overcome the barriers raised by Pap smears and enhance the coverage of cervical cancer screening. Promotional publicity and education are essential.
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Awareness of Cervical Cancer Causes and Predeterminants of Likelihood to Screen Among Women in Haiti. J Low Genit Tract Dis 2017; 21:37-41. [PMID: 27906806 DOI: 10.1097/lgt.0000000000000281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Cervical cancer is the leading cause of cancer deaths among women in Haiti. Given this high disease burden, we sought to better understand women's knowledge of its causes and the sociodemographic and health correlates of cervical cancer screening. MATERIALS AND METHODS Participants were 410 adult women presenting at clinics in Léogâne and Port-au-Prince, Haiti. We used bivariate and multivariate logic regression to identify correlates of Pap smear receipt. RESULTS Only 29% of respondents had heard of human papillomavirus (HPV), whereas 98% were aware of cervical cancer. Of those aware of cervical cancer, 12% believed that sexually transmitted infections (STIs) cause it, and only 4% identified HPV infection as the cause. Women with a previous sexually transmitted infection were more likely to have had Pap smear (34% vs 71%, odds ratio = 3.45; 95% CI = 1.57-7.59). Screening was also more likely among women who were older than the age of 39 years, better educated, and employed (all p < .05). Almost all women (97%) were willing to undergo cervical cancer screening. CONCLUSIONS This sample of Haitian women had limited awareness of HPV and cervical cancer causes; but when provided with health information, they saw the benefits of cancer screening. Future initiatives should provide health education messages, with efforts targeting young and at-risk women.
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Waller J, McCaffery K, Forrest S, Szarewski A, Cadman L, Austin J, Wardle J. Acceptability of unsupervised HPV self-sampling using written instructions. J Med Screen 2016; 13:208-13. [PMID: 17217611 DOI: 10.1177/096914130601300409] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The study measured the acceptability of self-sampling for human papillomavirus (HPV) testing in the context of cervical cancer screening. Women carried out self-sampling unsupervised, using a written instruction sheet. Setting Participants were women attending either a family planning clinic or a primary care trust for routine cervical screening. Methods Women (n = 902) carried out self-sampling for HPV testing and then a clinician did a routine cervical smear and HPV test. Immediately after having the two tests, participants completed a measure of acceptability for both tests, and answered questions about ease of using the instruction sheet and willingness to use self-sampling in the future. Results The majority of women found self-sampling more acceptable than the clinician-administered test, but there was a lack of confidence that the test had been done correctly. Significant demographic differences in attitudes were found, with married women having more favourable attitudes towards self-sampling than single women, and Asian women having more negative attitudes than women in other ethnic groups. Intention to use self-sampling in the future was very high across all demographic groups. Conclusion Self-sampling for HPV testing was highly acceptable in this large and demographically diverse sample, and women were able to carry out the test alone, using simple written instructions. Consistent with previous studies, women were concerned about doing the test properly and this issue will need to be addressed if self-sampling is introduced. More work is needed to see whether the demographic differences we found are robust and to identify reasons for lower acceptability among single women and those from Asian background.
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Affiliation(s)
- J Waller
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, UCL, London, UK.
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Ma'som M, Bhoo-Pathy N, Nasir NH, Bellinson J, Subramaniam S, Ma Y, Yap SH, Goh PP, Gravitt P, Woo YL. Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women. BMJ Open 2016; 6:e011022. [PMID: 27491667 PMCID: PMC4985871 DOI: 10.1136/bmjopen-2015-011022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women. METHOD A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting one's own sample. RESULTS Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38 years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87). CONCLUSIONS Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.
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Affiliation(s)
- Mahirah Ma'som
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- National Clinical Research Centre, Ministry of Health, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazrila Hairizan Nasir
- Selangor State Health Department, Klinik Kesihatan Pandamaran, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jerome Bellinson
- Preventive Oncology International Inc, Cleveland Heights, Ohio and The Women's Health Institute of the Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Yuntong Ma
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Siew-Hwei Yap
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Pik-Pin Goh
- National Clinical Research Centre, Ministry of Health, Malaysia
| | - Patti Gravitt
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
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Vaginal Self-Sampling for Human Papillomavirus Infection as a Primary Cervical Cancer Screening Tool in a Haitian Population. Sex Transm Dis 2016; 42:655-9. [PMID: 26462192 DOI: 10.1097/olq.0000000000000345] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) testing as primary cervical cancer screening has not been studied in Caribbean women. We tested vaginal self-collection versus physician cervical sampling in a population of Haitian women. METHODS Participants were screened for high-risk HPV with self-performed vaginal and clinician-collected cervical samples using Hybrid Capture 2 assays (Qiagen, Gaithersburg, MD). Women positive by either method then underwent colposcopy with biopsy of all visible lesions. Sensitivity and positive predictive value were calculated for each sample method compared with biopsy results, with κ statistics performed for agreement. McNemar tests were performed for differences in sensitivity at ≥cervical intraepithelial neoplasia (CIN)-I and ≥CIN-II. RESULTS Of 1845 women screened, 446 (24.3%) were HPV positive by either method, including 105 (5.7%) only by vaginal swab and 53 (2.9%) only by cervical swab. Vaginal and cervical samples were 91.4% concordant (κ = 0.73 [95% confidence interval, 0.69-0.77], P < 0.001). Overall, 133 HPV-positive women (29.9%) had CIN-I, whereas 32 (7.2%) had ≥CIN-II. The sensitivity of vaginal swabs was similar to cervical swabs for detecting ≥CIN-I (89.1% vs. 87.9%, respectively; P = 0.75) lesions and ≥CIN-II disease (87.5% vs. 96.9%, P = 0.18). Eighteen of 19 cases of CIN-III and invasive cancer were found by both methods. CONCLUSIONS Human papillomavirus screening via self-collected vaginal swabs or physician-collected cervical swabs are feasible options in this Haitian population. The agreement between cervical and vaginal samples was high, suggesting that vaginal sample-only algorithms for screening could be effective for improving screening rates in this underscreened population.
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Shim J, Pérez A, Symanski E, Nyitray AG. Association Between Serum 25-Hydroxyvitamin D Level and Human Papillomavirus Cervicovaginal Infection in Women in the United States. J Infect Dis 2016; 213:1886-92. [PMID: 26908722 DOI: 10.1093/infdis/jiw065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/05/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A sufficient level of vitamin D enhances protection against several infectious diseases; however, its association with cervicovaginal human papillomavirus (HPV) infection has not been studied. METHODS Data for this cross-sectional study were from National Health and Nutrition Examination Survey 2003-2006. A total of 2353 sexually active women for whom cervicovaginal HPV infection status and serum 25-hydroxyvitamin D (25[OH]D) level were known were studied. Associations between serum 25(OH)D levels (continuous and categorical forms) and cervicovaginal HPV infection (due to high-risk HPV or vaccine-type HPV) were estimated using weighted logistic regression. RESULTS After adjustment for age, race/ethnicity, and marital status, the odds of high-risk HPV infection were increased per each 10 ng/mL decrease in serum 25(OH)D level (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.02-1.27). Similarly, the odds of vaccine-type HPV infection were increased in women with vitamin D levels that were severely deficient (serum 25[OH]D level, <12 ng/mL; aOR, 2.90; 95% CI, 1.32-6.38), deficient (12-19 ng/mL; aOR, 2.19; 95% CI, 1.08-4.45), and insufficient (20-29 ng/mL; aOR, 2.19; 95% CI, 1.22-3.93), compared with those with vitamin D levels that were sufficient (≥30 ng/mL). CONCLUSIONS Cervicovaginal HPV prevalence is associated with less-than-optimal levels of serum vitamin D.
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Affiliation(s)
- Jinhee Shim
- Department of Business Intelligence and Analytics, Texas Children's Health Plan, Houston
| | - Adriana Pérez
- Department of Biostatistics, University of Texas School of Public Health, Austin
| | - Elaine Symanski
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston
| | - Alan G Nyitray
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston
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Racey CS, Gesink DC, Burchell AN, Trivers S, Wong T, Rebbapragada A. Randomized Intervention of Self-Collected Sampling for Human Papillomavirus Testing in Under-Screened Rural Women: Uptake of Screening and Acceptability. J Womens Health (Larchmt) 2015; 25:489-97. [PMID: 26598955 DOI: 10.1089/jwh.2015.5348] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Our aim was to determine if cervical cancer screening uptake would increase among under-screened women living in rural Ontario, Canada, if at-home self-collected sampling for human papillomavirus (HPV) testing was offered as a primary cervical cancer screening modality, compared to invited papanicolaou (Pap) testing or routine opportunistic screening. METHODS Women 30-70 years of age who were overdue for cervical cancer screening were randomized to receive (1) an at-home self-collected HPV kit, (2) a reminder invitation for Pap testing, or (3) standard of care opportunistic screening. The first two arms were also asked demographic and screening history questions. Women randomized to arm 1 were asked about acceptability. RESULTS In total, 818 eligible women were identified in a small rural community in Southwestern Ontario: 335 received a self-collected HPV testing kit, 331 received a reminder letter, and 152 received standard of care. In the HPV self-collection arm, 21% (70/335) returned the sample and questionnaire and 11% (37/335) opted to undergo Pap testing. In total, 32% from the HPV self-collection arm, 15% (51/331) from the Pap invitation arm, and 8.5% (13/152) with standard of care were screened. Women receiving the self-collected HPV kit were 3.7 (95% confidence interval 2.2-6.4) times more likely to undergo screening compared to the standard of care arm. In the HPV self-sampling arm, 80% (56/70) said they would be very likely to choose self-collected sampling in the future. CONCLUSIONS Providing self-collected sampling for HPV testing was more effective than sending reminder letters to increase screening coverage in under-screened women.
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Affiliation(s)
- C Sarai Racey
- 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Dionne C Gesink
- 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Ann N Burchell
- 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
- 2 Department of Community and Family Medicine, Li Ka Shing Knowledge Institute , St. Michael's Hospital, Toronto, Canada
| | | | - Tom Wong
- 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
- 4 Health Canada , Ottawa, Canada
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Othman NH, Mohamad Zaki FH. Self-collection tools for routine cervical cancer screening: a review. Asian Pac J Cancer Prev 2015; 15:8563-9. [PMID: 25374168 DOI: 10.7314/apjcp.2014.15.20.8563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Sub-optimal participation is a major problem with cervical cancer screening in developing countries which have no organized national screening program. There are various notable factors such as 'embarrassment', 'discomfort' and 'no time' cited by women as they are often also the bread winners for the family. Implementation of self-sampling methods may increase their participation. The aim of this article was to provide a survey of various types of self-sampling tools which are commonly used in collection of cervical cells. We reviewed currently available self-sampling devices and collated the advantages and disadvantages of each in terms of its acceptance and its accuracy in giving desired results. In general, regardless of which device is used, self-sampling for cervical scrapings is highly acceptable to women in most of the studies cited.
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Affiliation(s)
- Nor Hayati Othman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia E-mail :
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Chen SL, Hsieh PC, Chou CH, Tzeng YL. Determinants of women's likelihood of vaginal self-sampling for human papillomavirus to screen for cervical cancer in Taiwan: a cross-sectional study. BMC WOMENS HEALTH 2014; 14:139. [PMID: 25420580 PMCID: PMC4253005 DOI: 10.1186/s12905-014-0139-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/23/2014] [Indexed: 12/24/2022]
Abstract
Background Many Taiwanese women (43.8%) did not participate in regular cervical screening in 2011. An alternative to cervical screening, self-sampling for human papillomavirus (HPV), has been available at no cost under Taiwan’s National Health Insurance since 2010, but the extent and likelihood of HPV self-sampling were unknown. Methods A cross-sectional study was performed to explore determinants of women’s likelihood of HPV self-sampling. Data were collected by questionnaire from a convenience sample of 500 women attending hospital gynecologic clinics in central Taiwan from June to October 2012. Data were analyzed by descriptive statistics, chi-square test, and logistic regression. Results Of 500 respondents, 297 (59.4%) had heard of HPV; of these 297 women, 69 (23%) had self-sampled for HPV. Among the 297women who had heard of HPV, 234 (78.8%) considered cost a priority for HPV self-sampling. Likelihood of HPV self-sampling was determined by previous Pap testing, high perceived risk of cervical cancer, willingness to self-sample for HPV, high HPV knowledge, and cost as a priority consideration. Conclusions Outreach efforts to increase the acceptability of self-sampling for HPV testing rates should target women who have had a Pap test, perceive themselves at high risk for cervical cancer, are willing to self-sample for HPV, have a high level of HPV knowledge, and for whom the cost of self-sampling covered by health insurance is a priority. Electronic supplementary material The online version of this article (doi:10.1186/s12905-014-0139-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shu-Ling Chen
- Department of Nursing, Hungkuang University, Taichung, Taiwan.
| | - Pao-Chun Hsieh
- Department of Obstetrics and Gynecology, Cheng Ching Hospital, Taichung, Taiwan.
| | - Chia-Hui Chou
- Department of Nursing, Hungkuang University, Taichung, Taiwan.
| | - Ya-Ling Tzeng
- School of Nursing, China Medical University, Taichung, Taiwan. .,Department of Nursing, China Medical University Hospital, Taichung, Taiwan.
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Quincy BL. Acceptability of self-collected human papillomavirus specimens in cervical cancer screening: A review. World J Obstet Gynecol 2014; 3:90-97. [DOI: 10.5317/wjog.v3.i3.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/03/2014] [Accepted: 06/16/2014] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer morbidity and mortality is an important public health problem around the world. Some of the barriers to cervical cancer screening include the embarrassment, discomfort, lack of privacy and time and cost associated with clinician-collected, clinic-based screening with cytology or human papillomavirus tests. Self-collection of a human papillomavirus (HPV) test has been found to be generally more acceptable, less embarrassing, more comfortable, more private and easy to do and preferred to pelvic examination for cervical cytology by many women worldwide. The most commonly reported limitation to self-collection is a woman’s lack of confidence in her ability to perform it correctly. Self-collected human papillomavirus tests have been shown to be as or more sensitive than cytology or clinician-collected HPV tests. With confidence-building education about self-collection, it is likely a viable method to extend the reach of screening in high and low-resource areas around the world.
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Human papillomavirus self-sampling in Cameroon: women's uncertainties over the reliability of the method are barriers to acceptance. J Low Genit Tract Dis 2014; 17:235-41. [PMID: 23422643 DOI: 10.1097/lgt.0b013e31826b7b51] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The study aimed to assess acceptability and preference for self-collected human papillomavirus tests (self-HPV) compared with traditional physician-sampled Pap tests (physician sampling) in a low-resource country. MATERIALS AND METHODS Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to carry out an unsupervised self-HPV, followed by a physician-collected cervical sample for HPV testing and cytology. Subsequently the women were asked to answer a questionnaire. RESULTS A total of 243 women were prospectively enrolled in this study. Median age of participants was 39 years (range = 25-65 years). Acceptability score was higher for self-HPV (p < .001) compared with physician sampling. Preference was lower for self-HPV than physician sampling (29% vs 62%; p < .001). Most participants thought that physician sampling was more reliable than self-HPV (59% vs 1%; p < .001). Women who preferred physician sampling were significantly more likely to have low knowledge about cervical cancer and a low educational level. CONCLUSIONS Although most of the women were more comfortable and less embarrassed with the self-HPV, they did not trust the method and did prefer physician sampling. The study underlines the need not only to educate women about HPV, cervical cancer, and its prevention but also to reassure them about the accuracy of self-HPV.
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Gupta S, Singh V, Sehgal A, Sodhani P. Cervical cancer in resource-limited settings: preventable but not yet prevented. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.4.515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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de Almeida FG, Machado AP, Fernandes CEDS, Ferreira AT, Padovani CTJ, Tozetti IA. Molecular epidemiology of the human papillomavirus infection in self-collected samples from young women. J Med Virol 2013; 86:266-71. [PMID: 24009072 DOI: 10.1002/jmv.23725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2013] [Indexed: 11/12/2022]
Abstract
The prevalence of human papillomavirus (HPV) infection is the highest in young, sexually active women less than 35 years of age. Direct diagnosis of infection by enabling genotyping methods is important considering that the viral types are divided into high (HR-HPV) and low (LR-HPV) oncogenic risk. This study aimed to evaluate the epidemiological and molecular characteristics of HPV infection in self-collected samples from young women. A cross-sectional study of 245 sexually active students (18 to 35 years of age) was undertaken with self-collected samples. Extracted DNA was analyzed by polymerase chain reaction (PCR) with the PGMY 09/11 and PC04/GH20 primers for the detection of HPV DNA and the β-globin gene, respectively. Viral genotyping was performed by type-specific PCR (TS-PCR) and restriction fragment length polymorphism (RFLP). Of the 236 valid samples, 68 (28.9%) were positive for HPV DNA, as genotyped by TS-PCR and RFLP. The HR-HPV were most prevalent, especially HPV-16, -31, -33, and -45, and the most prevalent LR-HPV were HPV-6 and -83. Multi-type HPV infections were detected in 17 (25%) samples. HPV infection was statistically more prevalent among younger women with lower educational levels and who had more partners in the past 2 years. A high prevalence of HPV infection was found in the age group examined, especially HR-HPV types, as well as the presence of risk behaviors associated with HPV infection were observed. Considering these results, vaccinating females before the onset of sexual activity in Brazil should be emphasized.
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Affiliation(s)
- Flávia Gatto de Almeida
- Program of Infectious and Parasitary Diseases from Medicine School, Universidade Federal de MatoGrosso do Sul/UFMS, Campo Grande, Mato Grosso do Sul, Brazil
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Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta-analysis. Canadian Journal of Public Health 2013. [PMID: 23618210 DOI: 10.1007/bf03405681] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE HPV testing has emerged as an effective cervical cancer screening test. The use of HPV self-testing has the potential to address many barriers to screening and reach at-risk women through engagement in screening. However, there is a need to examine the evidence for whether offering self-collected HPV testing in practice increases screening compliance. The objective of this review is to determine to what extent providing self-collected HPV testing increases screening participation in women who are never or underscreened for cervical cancer. METHODS A systematic literature review conducted in the databases Medline and Embase identified articles examining the use of HPV self-testing on cervical cancer screening participation. A meta-analysis using a random-effects model was used to calculate the relative compliance, with an intent-to-treat analysis of HPV self-testing compared to Pap testing, with 95% confidence intervals (CI). All statistical tests were two-sided. SYNTHESIS Ten studies were reviewed, with 8 being European and 2 North American. Of the 10 studies, 9 employed a randomized design. In all studies, the relative compliance of HPV self-collected testing compared to Pap testing was significantly greater than 1.0 (p<0.01). The overall relative compliance was 2.14 (95% CI 1.30-3.52). There was large heterogeneity of screening compliance between studies for both HPV self-testing and Pap testing. CONCLUSION HPV self-collected testing significantly improved the participation of women who did not routinely attend cervical cancer screening programs. New approaches to HPV self-test delivery should be considered as HPV testing becomes more widely incorporated as a primary screening tool.
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Adler DH, Laher F, Lazarus E, Grzesik K, Gray GE, Allan B, Williamson AL. A Viable and Simple Self-Sampling Method for Human Papillomavirus Detection among South African Adolescents. ACTA ACUST UNITED AC 2013; 2. [PMID: 24324979 DOI: 10.4172/2329-9541.1000113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Self-sampling for Human Papillomavirus (HPV) testing may offer improved patient acceptability, decreased cost, and greater practicality than clinician collection of specimens. HPV testing among adolescents is necessary to conduct vaccine surveillance and may play a role in cervical cancer screening among some populations. METHODS A cross-sectional prevalence study was conducted to compare the results of self-collected and clinician-collected specimens for Human papillomavirus (HPV) testing among South African adolescent females. All participants provided self-sampled vaginal swabs and underwent clinician-collection of cervical swabs for HPV DNA analysis. The level of agreement between HPV DNA results from the two specimen collection methods was measured. RESULTS The level of agreement between HPV DNA results from self-collected and clinician-collected specimens was high (κ=86.7; p<0.001). A high prevalence of HPV overall was found by both specimen collection methods (57%; 95% CI 0.37-0.75). Low-risk HPV (LR-HPV) types were found slightly more frequently in self-collected specimens. CONCLUSION There is a high level of agreement between the HPV DNA results from self-collected and clinician-collected specimens. Self-collection of specimens for HPV testing is a viable alternative among adolescents.
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Affiliation(s)
- David H Adler
- Department of Emergency Medicine, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Cerigo H, Coutlée F, Franco EL, Brassard P. Dry self-sampling versus provider-sampling of cervicovaginal specimens for human papillomavirus detection in the Inuit population of Nunavik, Quebec. J Med Screen 2012; 19:42-8. [PMID: 22438506 DOI: 10.1258/jms.2012.012011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the comparability of self-collected cervicovaginal samples and provider-collected cervical samples for the detection of human papillomavirus (HPV) DNA among Inuit women in Nunavik, Quebec, avoiding the use of liquid-based storage and transport of the self-collected samples. METHODS Ninety-three women aged 18-69 years were recruited from a previously formed cohort on the natural history of HPV to this cross-sectional measurement study. This study utilized HPV DNA test results from 89 paired specimens collected by study participant and health provider with Dacron swabs. Samples were tested for 36 HPV types with the PGMY-primer PCR protocol and genotyping with the linear array method. Unweighted kappa statistics and McNemar tests were used to measure the agreement between sampling techniques. RESULTS In the self-collected samples, 30 different HPV types were found, compared with 29 types found in the provider-collected samples. The prevalence of high-risk (HR) HPV was 38.2% in the self-collected samples and 28.1% in the provider-collected samples. The agreement between collection methods for the detection of HR-HPV DNA (85.4%) was good. HR-HPV and type-specific HPV 16/18 were as likely to be detected in the self-collected samples compared with the provider-obtained samples. CONCLUSIONS Women in this population were easily able to collect adequate cervicovaginal specimens for HPV testing. As self-sampling has a high recovery of HR-HPV and is comparable with provider-sampling, we conclude that self-sampling with dry storage and transport could be a good cervical cancer screening alternative for Inuit women in Nunavik who have traditionally avoided speculum examination.
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Affiliation(s)
- Helen Cerigo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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Tricco AC, Ng CH, Gilca V, Anonychuk A, Pham B, Berliner S. Canadian oncogenic human papillomavirus cervical infection prevalence: systematic review and meta-analysis. BMC Infect Dis 2011; 11:235. [PMID: 21892939 PMCID: PMC3185279 DOI: 10.1186/1471-2334-11-235] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 09/05/2011] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Oncogenic human papillomavirus (HPV) infection prevalence is required to determine optimal vaccination strategies. We systematically reviewed the prevalence of oncogenic cervical HPV infection among Canadian females prior to immunization. METHODS We included studies reporting DNA-confirmed oncogenic HPV prevalence estimates among Canadian females identified through searching electronic databases (e.g., MEDLINE) and public health websites. Two independent reviewers screened literature results, abstracted data and appraised study quality. Prevalence estimates were meta-analyzed among routine screening populations, HPV-positive, and by cytology/histology results. RESULTS Thirty studies plus 21 companion reports were included after screening 837 citations and 120 full-text articles. Many of the studies did not address non-response bias (74%) or use a representative sampling strategy (53%). Age-specific prevalence was highest among females aged < 20 years and slowly declined with increasing age. Across all populations, the highest prevalence estimates from the meta-analyses were observed for HPV types 16 (routine screening populations, 8 studies: 8.6% [95% confidence interval 6.5-10.7%]; HPV-infected, 9 studies: 43.5% [28.7-58.2%]; confirmed cervical cancer, 3 studies: 48.8% [34.0-63.6%]) and 18 (routine screening populations, 8 studies: 3.3% [1.5-5.1%]; HPV-infected, 9 studies: 13.6% [6.1-21.1%], confirmed cervical cancer, 4 studies: 17.1% [6.4-27.9%]. CONCLUSION Our results support vaccinating females < 20 years of age, along with targeted vaccination of some groups (e.g., under-screened populations). The highest prevalence occurred among HPV types 16 and 18, contributing a combined cervical cancer prevalence of 65.9%. Further cancer protection is expected from cross-protection of non-vaccine HPV types. Poor study quality and heterogeneity suggests that high-quality studies are needed.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael's Hospital, (38 Shuter Street), Toronto, Ontario, (M5B 1T8), Canada
| | - Carmen H Ng
- School of Population and Public Health, University of British Columbia, (2206 East Mall), Vancouver, British Columbia, (V6T 1Z3), Canada
| | - Vladimir Gilca
- Centre de Recherche du CHUL (CHUQ), l'Université Laval, (2705 boulevard Laurier), Québec, Québec, (G1V 4G2), Canada
| | - Andrea Anonychuk
- GlaxoSmithKline Biologicals, (Avenue Fleming 20), Wavre (1300), Belgium
| | - Ba' Pham
- Health Policy Management and Evaluation, University of Toronto, (155 College Street), Toronto, Ontario, (M5T 3MT), Canada
- Toronto Health Economics and Technology Assessment, University of Toronto, (144 College Street), Toronto, Ontario, (M5S 3M2), Canada
| | - Shirra Berliner
- Department of Epidemiology, University of Western Ontario, (Kresge Building), London, Ontario, (N6A 5C1), Canada
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Gravitt PE, Belinson JL, Salmeron J, Shah KV. Looking ahead: a case for human papillomavirus testing of self-sampled vaginal specimens as a cervical cancer screening strategy. Int J Cancer 2011; 129:517-27. [PMID: 21384341 DOI: 10.1002/ijc.25974] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Even in the era of highly effective human papillomavirus (HPV) prophylactic vaccines, substantial reduction in worldwide cervical cancer mortality will only be realized if effective early detection and treatment of the millions of women already infected and the millions who may not receive vaccination in the next decade can be broadly implemented through sustainable cervical cancer screening programs. Effective programs must meet three targets: (i) at least 70% of the targeted population should be screened at least once in a lifetime, (ii) screening assays and diagnostic tests must be reproducible and sufficiently sensitive and specific for the detection of high-grade precursor lesions (i.e., CIN21), and (iii) effective treatment must be provided. We review the evidence that HPV DNA screening from swabs collected by the women in their home or village is sufficiently sound for consideration as a primary screening strategy in the developing world, with sensitivity and specificity for detection of CIN21 as good or better than Pap smear cytology and VIA. A key feature of a self-collected HPV testing strategy (SC-HPV) is the move of the primary screening activities from the clinic to the community. Efforts to increase the affordability and availability of HPV DNA tests, community education and awareness, development of strong partnerships between community advocacy groups, health care centers and regional or local laboratories, and resource appropriate strategies to identify and treat screen-positive women should now be prioritized to ensure successful public health translation of the technologic advancements in cervical cancer prevention.
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Affiliation(s)
- Patti E Gravitt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Virtanen A, Nieminen P, Luostarinen T, Anttila A. Self-sample HPV Tests As an Intervention for Nonattendees of Cervical Cancer Screening in Finland: a Randomized Trial. Cancer Epidemiol Biomarkers Prev 2011; 20:1960-9. [DOI: 10.1158/1055-9965.epi-11-0307] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Schmeink CE, Bekkers RLM, Massuger LFAG, Melchers WJG. The potential role of self-sampling for high-risk human papillomavirus detection in cervical cancer screening. Rev Med Virol 2011; 21:139-53. [DOI: 10.1002/rmv.686] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Channa E. Schmeink
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Leon F. A. G. Massuger
- Department of Obstetrics and Gynaecology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
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Ayres ARG, Silva GAE. Cervical HPV infection in Brazil: systematic review. Rev Saude Publica 2011; 44:963-74. [PMID: 20877926 DOI: 10.1590/s0034-89102010000500023] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 02/22/2010] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess the prevalence of human papillomavirus (HPV) infection in women in Brazil. METHODS A systematic literature review was conducted with an active search in PubMed and Virtual Health Library databases using the terms "human papillomavirus," "HPV," "prevalence," and "Brazil". Of 155 articles retrieved, 82 were selected after reading their title and abstract. After a thorough examination, 14 articles were included in the study. RESULTS The 14 articles selected were published between 1989 and 2008 and comprised studies from four Brazilian macroregions (Southeast - 43%; South - 21.4%; Northeast - 21.4%; and North - 7.1%). Nine were cross-sectional studies. Eight articles used polymerase chain reaction and seven used hybrid capture for HPV detection. The study samples ranged from 49 to 2,329 women. The overall prevalence of HPV cervical infection was between 13.7% and 54.3%; and women with cytologically normal results had 10% to 24.5% prevalence of HPV cervical infection. Four articles described the most common HPV types. CONCLUSIONS The cytology techniques available use different classifications leading to different HPV prevalence estimates. However, considering the studies individually according to the detection technique used, the HPV prevalence has increased. HPV16 was the most prevalent type among women, regardless of the cytology result. The concentration of studies in the Southeast region, especially in metropolitan regions, evidences that further investigations are needed to improve information coverage of Brazilian women.
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Affiliation(s)
- Andréia Rodrigues Gonçalves Ayres
- Programa de Pós-graduação em Saúde Coletiva, Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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Moscicki AB, Widdice L, Ma Y, Farhat S, Miller-Benningfield S, Jonte J, Jay J, de Medina CG, Hanson E, Clayton L, Shiboski S. Comparison of natural histories of human papillomavirus detected by clinician- and self-sampling. Int J Cancer 2010; 127:1882-92. [PMID: 20104517 DOI: 10.1002/ijc.25199] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
New strategies for cervical cancer screening include human papillomavirus (HPV) DNA testing. Using self-testing methods would increase access to testing in both developed and developing countries. The purpose of this study was to compare time-to-clearance of specific HPV types between clinician-collected-lavage (CC-L) and self-collected (SC) sampling in a single cohort. CC-L and SC samples were obtained every 4 months at alternate 2-month windows from 537 women. Eighteen high-risk (HR) HPV and 4 low-risk (LR) HPV were examined. Proportional hazards model was used to compare time-to-clearance between methods for combined HR and for 13 specific HPV types. Prentice-Wilcoxon test was used for within-subject paired comparison. In the independent analysis for combined HR and LR types, no differences were found. For specific types, time-to-clearance for all HPV types examined between CC-L and SC samples was similar except for HPV 66 which showed a trend to clear slower by SC (p = 0.09). When comparing methods in the same woman, time-to-clearance was similar for all types except for HPV 16 which showed a trend to clear slower by CC-L means (p = 0.08). When we examined pattern of clearance among the CC-L samples, the fastest types to clear were HPV 6, 18, 66, 84 and 39 and the slowest were HPV 62, 68, 59 and 16. These patterns of fast and slow were similar for SC samples. Our findings suggest using SC vaginal swabs would observe similar natural histories of HPV compared to studies using CC-L specimens making self-testing feasible for repeated HPV DNA detection.
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Affiliation(s)
- Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, CA 94118, USA.
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Tamalet C, Richet H, Carcopino X, Henry M, Leretraite L, Heid P, Leandri FX, Sancho-Garnier H, Piana L. Testing for human papillomavirus and measurement of viral load of HPV 16 and 18 in self-collected vaginal swabs of women who do not undergo cervical cytological screening in Southern France. J Med Virol 2010; 82:1431-7. [DOI: 10.1002/jmv.21835] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gök M, Heideman DAM, van Kemenade FJ, Berkhof J, Rozendaal L, Spruyt JWM, Voorhorst F, Beliën JAM, Babovic M, Snijders PJF, Meijer CJLM. HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: cohort study. BMJ 2010; 340:c1040. [PMID: 20223872 PMCID: PMC2837143 DOI: 10.1136/bmj.c1040] [Citation(s) in RCA: 228] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine whether offering self sampling of cervicovaginal material for high risk human papillomavirus (HPV) testing is an effective screening method for women who do not attend regular cervical screening programmes. DESIGN Cohort study (the PROHTECT trial). Settings Noord-Holland and Flevoland regions of the Netherlands, December 2006 to December 2007, including 13 laboratories, gynaecologists, and more than 800 general practitioners. PARTICIPANTS 28 073 women who had not responded to two invitations to the regular cervical screening programme: 27 792 women were assigned to the self sampling group and invited to submit a self collected cervicovaginal sample for HPV testing; 281 were assigned to the recall control group and received a second re-invitation for conventional cytology. INTERVENTION Women with a positive result on the high risk HPV test on their self sample material were referred to their general practitioner. Women with abnormal results on cytology were referred for colposcopy. Women with normal results on cytology were re-evaluated after one year by cytology and high risk HPV testing and referred for colposcopy if either result was positive. MAIN OUTCOME MEASURES Attendance rate in both groups and yield of cervical intraepithelial neoplasia grade II/III or worse (>or=CIN II/>or=CIN III) in self sampling responders. RESULTS The compliance rate in the self sampling group was significantly higher than in the control group (crude 26.6% v 16.4%, P<0.001; adjusted 27.5% v 16.6%, P<0.001). The number of detected >or=CIN II and >or=CIN III lesions in self sampling responders was 99 (1.3%) and 76 (1.0%), respectively. Self sampling responders who had not participated in the previous round of screening (43%) had increased relative risks of >or=CIN II (2.04, 95% confidence interval 1.27 to 3.28) and >or=CIN III (2.28, 1.31 to 3.96) compared with self sampling women who had been screened in the previous round (57%). CONCLUSIONS Offering self sampling by sending a device for collecting cervicovaginal specimens for high risk HPV testing to women who did not attend regular screening is a feasible and effective method of increasing coverage in a screening programme. The response rate and the yield of high grade lesions support implementation of this method for such women. Trial registration ISRCTN45527158.
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Affiliation(s)
- Murat Gök
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, Netherlands
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Barbee L, Kobetz E, Menard J, Cook N, Blanco J, Barton B, Auguste P, McKenzie N. Assessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action. Cancer Causes Control 2009; 21:421-31. [DOI: 10.1007/s10552-009-9474-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 11/10/2009] [Indexed: 12/24/2022]
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Althoff KN, Paul P, Burke AE, Viscidi R, Sangaramoorthy M, Gravitt PE. Correlates of cervicovaginal human papillomavirus detection in perimenopausal women. J Womens Health (Larchmt) 2009; 18:1341-6. [PMID: 19702476 DOI: 10.1089/jwh.2008.1223] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this research was to determine correlates of prevalent cervicovaginal human papillomavirus (HPV) infection in perimenopausal women. METHODS A total of 178 women, ages 40-60, were recruited from four clinics in the metropolitan area of Baltimore, Maryland. A self-collected cervicovaginal specimen and questionnaire were completed following enrollment and consent. HPV was detected by L1 consensus polymerase chain reaction (PCR) and genotyped using a prototype line blot assay. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) from Poisson regression models with robust variance identified correlates of prevalent HPV infection. RESULTS Prevalence of any HPV genotype at baseline among 172 women with complete data was 20% (6% for high-risk HPV). HPV prevalence was higher among single compared to married women (aPR = 4.3 [95% CI: 2.0, 9.5]), and among women with >or=2 sex partners in the last six months compared to women who reported none (aPR = 4.9 [1.7, 13.9]) after adjustment for confounders. Menopausal stage was also associated with HPV detection, with increased prevalence among perimenopausal compared to premenopausal women (aPR 2.3 [1.1, 5.1]), after adjustment for confounders. Age was moderately correlated with menopausal staging (r = 0.57). CONCLUSIONS Our observations suggest the independent associations of sexual behavior and hormones on prevalent HPV in perimenopausal women. Age was not a good surrogate for menopausal stage, as it was only moderately correlated with menopausal stage.
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Affiliation(s)
- Keri N Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA
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De Alba I, Anton-Culver H, Hubbell FA, Ziogas A, Hess JR, Bracho A, Arias C, Manetta A. Self-sampling for human papillomavirus in a community setting: feasibility in Hispanic women. Cancer Epidemiol Biomarkers Prev 2008; 17:2163-8. [PMID: 18708409 DOI: 10.1158/1055-9965.epi-07-2935] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of the study was (a) to assess sensitivity and specificity of self-sampling in a community setting for identifying high-risk human papillomavirus (HPV) infection and abnormal Papanicolaou (Pap) smears and (b) to assess satisfaction with this collection method among Hispanic women. METHODS Lay health workers distributed self-collection kits to Hispanic women in the community. Participants collected an unsupervised vaginal sample at home or in the place and time of their preference. RESULTS A total of 1,213 Hispanics were included and provided a self-sample for HPV testing and were invited for a Pap smear; 662 (55%) of them had a Pap smear and the first 386 of these also had a physician-collected sample for HPV retesting. Using physician collection as the gold standard, unsupervised self-collection had a sensitivity of 90% and specificity of 88% for identifying high-risk HPV. Compared with physician sampling, self-sampling in a community setting had comparable sensitivity for identifying a low-grade lesions or greater in the Pap smear (50% versus 55%; P = 0.45) but lower specificity (94% versus 79%). Overall experience with self-sampling was reported as excellent or very good by 64% and only 2.6% reported a poor or fair experience. CONCLUSIONS Unsupervised self-collection of vaginal samples for HPV testing in a community setting has a high sensitivity for identifying high-risk HPV and a high satisfaction among Hispanics. This approach may benefit populations with limited access to health care or with cultural barriers to cervical cancer screening.
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Affiliation(s)
- Israel De Alba
- Department of Medicine, School of Medicine, University of California-Irvine, Irvine, California, USA.
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A new HPV-DNA test for cervical-cancer screening in developing regions: a cross-sectional study of clinical accuracy in rural China. Lancet Oncol 2008; 9:929-36. [PMID: 18805733 DOI: 10.1016/s1470-2045(08)70210-9] [Citation(s) in RCA: 339] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A new test (careHPV; QIAGEN, Gaithersburg, MD, USA) has been developed to detect 14 high-risk types of carcinogenic human papillomavirus (HPV) in about 2.5 h, to screen women in developing regions for cervical intraepithelial neoplasia (CIN). We did a cross-sectional study to assess the clinical accuracy of careHPV as a rapid screening test in two county hospitals in rural China. METHODS From May 10 to June 15, 2007, the careHPV test was done locally by use of self-obtained vaginal and provider-obtained cervical specimens from a screening population-based set of 2530 women aged 30 to 54 years in Shanxi province, China. All women were assessed by visual inspection with acetic acid (VIA), Digene High-Risk HPV HC2 DNA Test (HC2), liquid-based cytology, and colposcopy with directed biopsy and endocervical curettage as necessary. In 2388 women with complete data, 441 women with negative colposcopy, but unsatisfactory or abnormal cytology or who were positive on HC2 or the new careHPV test, were recalled for a second colposcopy, four-quadrant cervical biopsies, and endocervical curettage. An absence of independence between the tests was not adjusted for and the Bonferroni correction was used for multiple comparisons. FINDINGS Complete data were available for 2388 (94.4%) women. 70 women had CIN2+ (moderate or severe CIN or cancer), of whom 23 had CIN3+. By use of CIN2+ as the reference standard and area-under-the-curve analysis with a two-sided alpha error level of 0.0083, the sensitivities and specificities of the careHPV test for a cut-off ratio cut-point of 0.5 relative light units, were 90.0% (95% CI 83.0-97.0) and 84.2% (82.7-85.7), respectively, on cervical specimens, and 81.4% (72.3-90.5) and 82.4% (80.8-83.9), respectively, on vaginal specimens (areas under the curve not significantly different, p=0.0596), compared with 41.4% (29.9-53.0) and 94.5% (93.6-95.4) for VIA (areas under the curve significantly different, p=0.0001 and p=0.0031, for cervical and vaginal-specimen comparisons for the careHPV test, respectively). The sensitivity and specificity of HC2 for cervical specimens were 97.1% (93.2-100) and 85.6% (84.2-87.1), respectively (areas under the curve not significantly different from the careHPV test on cervical specimens, p=0.0163). INTERPRETATION The careHPV test is promising as a primary screening method for cervical-cancer prevention in low-resource regions.
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Bahamondes L, Diaz J, Marchi NM, Castro S, Villarroel M, Macaluso M. Prostate-specific antigen in vaginal fluid after exposure to known amounts of semen and after condom use: comparison of self-collected and nurse-collected samples. Hum Reprod 2008; 23:2444-51. [PMID: 18664473 DOI: 10.1093/humrep/den283] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) in vaginal fluid indicates exposure to semen, and was used to assess condom effectiveness, although validity and reliability have not been fully evaluated. Our objective was to compare PSA in self-collected samples with samples collected by a nurse. METHODS We conducted two studies, each with 100 women aged 18-48 years. In the first, a nurse exposed each participant to her partner's semen (10, 100 and 1000 microl), and nurse and participant collected samples. In the second, each participant sampled before and after using two male condoms (MC) and two female condoms (FC); a nurse collected another sample afterwards. RESULTS PSA concentration increased with semen exposure, but was lower in nurse-collected samples. Both procedures were sensitive, almost 100% after exposure to 100-1000 microl of semen. PSA detection rates with MC and FC were 13% and 28% in self-collected samples, 8% and 9% in nurse-collected samples. Concordance between sample types was 93% with the MC (95% CI: 89%; 96%), 78% with the FC (95% CI: 72%; 84%). PSA decay between sampling times may explain higher values in self-collected samples. CONCLUSIONS PSA is a highly sensitive surrogate endpoint for condom effectiveness studies. Self-collected and nurse-collected samples are equivalent, but sample collection timing is critical.
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Affiliation(s)
- Luis Bahamondes
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
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