Affiliation: School of Medicine, Department of Allied Health Sciences, Physician Assistant Program
Background Cervical cancer is a female specific cancer and the fourth most common cancer type worldwide with incidence rates in the United States of 8.1 cases per 100,000 women. Cervical cancer mortality has decreased since the start of screening programs with the Papanicolaou test in the 1940s, but more can be done to ensure screening reaches increasing numbers of women. One of the methods that could be used in the future to reach women for screening is using self-sampling testing for high risk HPV strains that cause over 90% of cervical cancers.
Objectives This review aims to answer the question: Is hrHPV testing via self-sampling an accurate and acceptable method of screening for cervical cancer when compared with the reference of cervical cytology otherwise known as the Papanicolaou test.
Methods PubMed, Medline and Embase were searched using the terms “cervical cancer”, HPV, “human papillomavirus” “cervical HPV”, “Pap”, “Papanicolaou”, “cytology”, “HPV cotesting”, “self-sampling” and “hrhpv testing.” Three primary research studies and three systematic review were included.
Results Sensitivity of HPV testing in self samples ranged between 51% and 93% for CIN2+32 and between 63% and 94% for CIN3+32. Rates of hrHPV positivity in self versus clinician collected samples were very similar (560 positive results self-collected, 554 positive results clinician collected15.) Noninferiority of HPV self-sampling was indicated by one included RCT16. 80% of women in an underserved area returned self-testing samples14 and most of these women indicated a positive experience with self-testing. Women were found to be twice as likely to be screened if they used self-sampling compared to standard of care screening (RR: 2.13, 95% CI 1.89-2.40)17. One review found that there was no consensus among women whether clinician or self-collected testing was preferred18.
Conclusions Overall, self-sampling appears to be an accurate method of testing for hrHPV in women. Most papers in this review point to the acceptability of self-testing among women. More research is most definitely needed surrounding accuracy of self-testing methods and how to encourage follow up care.