Cervical cancer screening: Is self‐sampling the answer?
Abstract
Objective
To evaluate the performance of self and clinician collected samples for high‐risk human papilloma virus (hr HPV) DNA detection and to assess the acceptance and attitude of women towards self‐collection.
Methods
This was a prospective single blind study done in 396 women (30–65 years) attending the gynecology outpatient department (OPD). Cervical swabs were collected in duplicate (self and clinician) in transport medium and stored at 4°C until further processing. A cervical smear was also collected at the same time. High risk HPV DNA was tested using real‐time polymerase chain reaction (PCR). The samples positive for HPV DNA in any of the samples either self or clinician underwent a colposcpy guided biopsy.
Results
A total of 396 women underwent screening. A total of 8% women complained of post coital bleeding. Cervical smear was inadequate in 15% and atypical squamous cells of undetermined significance (ASCUS) and above was reported in 3.7% samples. Overall agreement between self and clinician sampled HPV (C‐HPV) was 91.4% with Kappa unadjusted being 43.4% (95% CI: 35.8–51.1). Overall agreement between C‐HPV and cervical smear was 79.5% with Kappa unadjusted of 19.2% (95% CI: 12.8–25.5). Overall agreement between self and cervical smear was 80.0% with Kappa unadjusted value of 21.7% (95% CI: 14.7 to 28.7). A total of 23 women underwent biopsy of which 19 were diagnosed with cervical intraepithelial neoplasia‐1 (CIN‐1) and above with a positive predictivity rate of 100% with either screening result being positive.
Conclusion
HPV DNA self‐sampling can be a major breakthrough in breaking the shackles of underutilization of cervical cancer screening and thus decrease the morbidity and mortality of cervical cancer.