Skip to main content
SpringerLink
Log in

Feasibility of Cervical Cancer Screening Utilizing Self-sample Human Papillomavirus Testing Among Mexican Immigrant Women in Harris County, Texas: A Pilot Study

  • Original paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Here we evaluate the acceptability and feasibility of self-sample human papillomavirus (HPV) testing (self-HPV) among a sample of predominantly Mexican immigrant women who never or sporadically attend for Pap testing. Immigrant women who had not had a Pap test in the past 3 years (n = 100) were recruited. Participants self-collected a cervical sample for HPV testing. High-risk (HR) HPV-positive women were referred for clinical follow-up. Acceptability of self-HPV was high, with 99 % reporting that they would be willing to use self-HPV regularly. Nineteen women (19 %) tested positive for HR–HPV. Of these, 50 % obtained clinical follow-up within 3 months. For those who did not, the primary barrier to follow-up was difficulty obtaining healthcare coverage. In conclusion, self-HPV is highly acceptable to Mexican immigrant women who otherwise do not attend for Pap testing. While the approach addresses critical barriers to primary screening, questions remain as to whether uninsured HR–HPV positive women are able to attend for clinical follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Watson M, Saraiya M, Benard V, et al. Burden of cervical cancer in the United States, 1998–2003. Cancer. 2008;113(10 Suppl):2855–64.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control and Prevention (CDC). Invasive cervical cancer among Hispanic and non-Hispanic women–United States, 1992–1999. MMWR Morb Mortal Wkly Rep. 2002;51(47):1067–70.

    Google Scholar 

  3. Horner MJ, Altekruse SF, Zou Z, Wideroff L, Katki HA, Stinchcomb DG. U.S. geographic distribution of prevaccine era cervical cancer screening, incidence, stage, and mortality. Cancer Epidemiol Biomarkers Prev. 2011;20(4):591–9.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services. Cancer statistics in Texas. 2014. https://www.dshs.state.tx.us/tcr/data.shtm. Accessed May 2 2014.

  5. Howlader N, Noone A, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2011. Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.

  6. Montealegre JR, Zhou R, Amirian ES, Follen M, Scheurer ME. Nativity disparities in late-stage diagnosis and cause-specific survival among Hispanic women with invasive cervical cancer: an analysis of surveillance, epidemiology, and end results data. Cancer Causes Control. 2013;24(11):1985–94.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Schur CL, Bernstein AB, Berk ML. The importance of distinguishing Hispanic subpopulations in the use of medical care. Med Care. 1987;25(7):627–41.

    Article  CAS  PubMed  Google Scholar 

  8. Goel MS, Wee CC, McCarthy EP, Davis RB, Ngo-Metzger Q, Phillips RS. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med. 2003;18(12):1028–35.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Singh GK, Hiatt RA. Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979–2003. Int J Epidemiol. 2006;35(4):903–19.

    Article  PubMed  Google Scholar 

  10. U.S. Preventive Services Task Force. Screening for cervical cancer: USA Preventive Services Task Force Recommendation Statement. 2012. http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed 3 September 2014.

  11. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12–9.

    Article  CAS  PubMed  Google Scholar 

  12. Ronco G, Giorgi-Rossi P, Carozzi F, et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. Lancet Oncol. 2010;11(3):249–57.

    Article  CAS  PubMed  Google Scholar 

  13. Mayrand MH, Duarte-Franco E, Rodrigues I, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16):1579–88.

    Article  CAS  PubMed  Google Scholar 

  14. Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360(14):1385–94.

    Article  CAS  PubMed  Google Scholar 

  15. Anttila A, Kotaniemi-Talonen L, Leinonen M, et al. Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organised screening programme. BMJ. 2010;340:1804.

    Article  Google Scholar 

  16. Leinonen M, Nieminen P, Kotaniemi-Talonen L, et al. Age-specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting. J Natl Cancer Inst. 2009;101(23):1612–23.

    Article  CAS  PubMed  Google Scholar 

  17. U.S. Food and Drug Administration (FDA). FDA News Release: FDA approves first human papillomavirus test for primary cervical cancer screening. 2014. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm394773.htm. Accessed 5 June 2014.

  18. Ogilvie GS, Patrick DM, Schulzer M, et al. Diagnostic accuracy of self collected vaginal specimens for human papillomavirus compared to clinician collected human papillomavirus specimens: a meta-analysis. Sex Transm Infect. 2005;81(3):207–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Petignat P, Faltin DL, Bruchim I, Tramer MR, Franco EL, Coutlee F. Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis. Gynecol Oncol. 2007;105(2):530–5.

    Article  PubMed  Google Scholar 

  20. Lazcano-Ponce E, Lorincz AT, Cruz-Valdez A, et al. Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): a community-based randomised controlled trial. Lancet. 2011;378(9806):1868–73.

    Article  PubMed  Google Scholar 

  21. Barbee L, Kobetz E, Menard J, et al. Assessing the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action. Cancer Causes Control. 2010;21(3):421–31.

    Article  PubMed  Google Scholar 

  22. Petignat P, Vassilakos P. Is it time to introduce hpv self-sampling for primary cervical cancer screening? J Natl Cancer Inst. 2012;104(3):166–7.

    Article  PubMed  Google Scholar 

  23. Khan MJ, Castle PE, Lorincz AT, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst. 2005;97(14):1072–9.

    Article  PubMed  Google Scholar 

  24. Dzuba IG, Diaz EY, Allen B, et al. The acceptability of self-collected samples for HPV testing versus the pap test as alternatives in cervical cancer screening. J Womens Health Gend Based Med. 2002;11(3):265–75.

    Article  PubMed  Google Scholar 

  25. De Alba I, Anton-Culver H, Hubbell FA, et al. Self-sampling for human papillomavirus in a community setting: feasibility in Hispanic women. Cancer Epidemiol Biomarkers Prev. 2008;17(8):2163–8.

    Article  PubMed  Google Scholar 

  26. Scarinci IC, Litton AG, Garces-Palacio IC, Partridege EE, Castle PE. Acceptability and usability of self-collected sampling for HPV testing among African-American women living in the Mississippi Delta. Womens Health Issues. 2013;23(2):e123–30.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Castle PE, Rausa A, Walls T, et al. Comparative community outreach to increase cervical cancer screening in the Mississippi Delta. Prev Med. 2011;52(6):452–5.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Léniz J, Barriga MI, Lagos M, Ibanez C, Pushchel K, Ferreccio C. HPV vaginal self-sampling among women non-adherent to Papanicolaou screening in Chile. Salud Publica Mex. 2013;55:162–9.

    Article  PubMed  Google Scholar 

  29. Trope LA, Chumworathayi B, Blumenthal PD. Feasibility of community-based careHPV for cervical cancer prevention in rural Thailand. J Low Genit Tract Dis. 2013;17(3):315–9.

    Article  PubMed  Google Scholar 

  30. Rosenbaum AJ, Gage JC, Alfaro KM, et al. Acceptability of self-collected versus provider-collected sampling for HPV DNA testing among women in rural El Salvador. Int J Gynecol Obst. 2014;126(2):156–60.

    Article  Google Scholar 

  31. Bansil P, Wittet S, Lim JL, Winkler JL, Pail P, Jeronimo J. Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach. BMC Public Health. 2014;14(1):1–9.

    Article  Google Scholar 

  32. Bais AG, van Kemenade FJ, Berkhof J, et al. Human papillomavirus testing on self-sampled cervicovaginal brushes: an effective alternative to protect nonresponders in cervical screening programs. Int J Cancer. 2007;120(7):1505–10.

    Article  CAS  PubMed  Google Scholar 

  33. Gok M, Heideman DA, van Kemenade FJ, et al. HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: cohort study. BMJ. 2010;340:1040.

    Article  Google Scholar 

  34. Gok M, vab Kemenade FJ, Heideman DA, et al. Experience with high-risk human papillomavirus testing on vaginal brush-based self-samples of non-attendees of the cervical screening program. Int J Cancer. 2012;130(5):1128–35.

    Article  PubMed  Google Scholar 

  35. Sanner K, Wikstrom I, Strand A, Lindell M, Wilander E. Self-sampling of the vaginal fluid at home combined with high-risk HPV testing. Br J Cancer. 2009;101(5):871–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Giorgi Rossi P, Marsili LM, Camilloni L, et al. The effect of self-sampled HPV testing on participation to cervical cancer screening in Italy: a randomised controlled trial (ISRCTN96071600). Br J Cancer. 2011;104(2):248–54.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Virtanen A, Nieminen AP, 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(9):1960–9.

    Article  PubMed  Google Scholar 

  38. Szarewski A, Cadman L, Mesher D, et al. HPV self-sampling as an alternative strategy in non-attenders for cervical screening—a randomised controlled trial. Br J Cancer. 2011;104(6):915–20.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Piana L, Leanidri FX, Le Retraite L, Heid P, Tamalet C, Sancho-Garnier H. HPV–HR detection by home self sampling in women not compliant with pap test for cervical cancer screening. Results of a pilot programme in Bouches-du-Rhone. Bull Cancer. 2011;98(7):723–31.

    PubMed  Google Scholar 

  40. Wikstrom I, Lindell M, Sanner K, Wilander E. Self-sampling and HPV testing or ordinary Pap-smear in women not regularly attending screening: a randomised study. Br J Cancer. 2011;105(3):337–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Migrant Clinicians Network. Ventanillas de Salud: Surge a traves de la necesidad. 2011. http://www.migrantclinician.org/services/ventanillas-de-salud.html. Accessed 19 Sept 2011.

  42. Harris Health System. Patient financial assistance and eligibility. 2014. https://www.harrishealth.org/en/patients/access-care/eligibility-card/pages/default.aspx. Accessed 1 Sept 2014.

  43. Selwyn BJ, Loe HD. The Valley Primary Health Review: a report of the Indigent Health Care Review Committee of the Health Planning Advisory Committee of the Lower Rio Grande Valley Development Council. 1989.

  44. Montealegre JR, Selwyn BJ. Healthcare coverage and use among undocumented Central American immigrant women in Houston, Texas. J Immigr Minor Health. 2014;16(2):204–10.

  45. Shi JF, Canfell K, Lew JB, et al. Evaluation of primary HPV-DNA testing in relation to visual inspection methods for cervical cancer screening in rural China: an epidemiologic and cost-effectiveness modelling study. BMC Cancer. 2011;11:239.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Larkey L. Las mujeres saludables: reaching Latinas for breast, cervical and colorectal cancer prevention and screening. J Community Health. 2006;31(1):69–77.

    Article  PubMed  Google Scholar 

  47. Messias DK, Parra-Medina D, Sharpe PA, Trevino L, Koskan AM, Morales-Campos D. Promotoras de Salud: roles, responsibilities, and contributions in a multisite community-based randomized controlled trial. Hisp Health Care Int. 2013;11(2):62–71.

    Article  PubMed  Google Scholar 

  48. Saad-Harfouche FG, Jandor L, Gage E, Thelemaque LD, Colon J, Castillo AG, Erwin DO. Esperanza y Vida: training lay health advisors and cancer survivors to promote breast and cervical cancer screening in Latinas. J Community Health. 2011;36(2):219–27.

    Article  PubMed  Google Scholar 

  49. Fernandez M, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W. Effectiveness of Cultivando la Salud: a bredast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health. 2009;99(5):936–43.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Eperon I, Vassilakos P, Navarria I, et al. Randomized comparison of vaginal self-sampling by standard versus dry swabs for Human papillomavirus testing. BMC Cancer. 2013;13:353.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Haguenoer K, Giraudeau B, Gaudy-Graffin C, et al. Accuracy of dry vaginal self-sampling for detecting high-risk human papillomavirus infection in cervical cancer screening: a cross-sectional study. Gynecol Oncol. 2014;134(2):302–8.

    Article  CAS  PubMed  Google Scholar 

  52. Wolfrum SG, Koutsky LA, Hughes JP, Feng Q, Xi LF, Shen Z, Winer RL. Evaluation of dry and wet transport of at-home self-collected vaginal swabs for human papillomavirus testing. J Med Microbiol. 2012;61(11):1538–45.

    Article  CAS  PubMed  Google Scholar 

  53. Agency for Healthcare Research and Quality (AHRQ). Healthcare innovations exchange: bilingual, culturally competent community health workers increase insurance enrollment, access to care, and self-efficacy among low-income Latinos. 2012.

Download references

Acknowledgments

We would like to thank our community partners at the Harris Health System, the Mexican Consulate, the Ventanilla de Salud, and the Community Network for Cancer Prevention for their support of this study. We are indebted to Maria Daheri, RN, the cervical case manager at Harris Health System who scheduled Pap test appointments and followed up with Pap test results. Additionally, we thank Dr. Glori Chauca and J.D. Franklin for their assistance in developing our instructional materials. This work is supported by the Dan L. Duncan Cancer Center (DLDCC) at Baylor College of Medicine. The Community Network for Cancer Prevention is funded by the Cancer Prevention and Research Institute of Texas (CPRIT), grant # PP100201. JRM was supported by a UTHealth Innovation for Cancer Prevention Research Postdoctoral Fellowship, CPRIT grant #RP101503. The content is solely the responsibility of the authors and does not necessarily represent the official views or DLDCC or CPRIT.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS: BCM 305, Houston, TX, 77030, USA

    Jane R. Montealegre & Michael E. Scheurer

  2. Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA

    Jane R. Montealegre, Maria L. Jibaja-Weiss & Michael E. Scheurer

  3. Division of Health Promotion and Behavioral Science, University of Texas School of Public Health, Houston, TX, USA

    Patricia D. Mullen

  4. School of Allied Health Sciences, Baylor College of Medicine, Houston, TX, USA

    Maria L. Jibaja-Weiss

  5. Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA

    Maria M. Vargas Mendez

Authors
  1. Jane R. Montealegre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia D. Mullen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria L. Jibaja-Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria M. Vargas Mendez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael E. Scheurer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jane R. Montealegre.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Montealegre, J.R., Mullen, P.D., L. Jibaja-Weiss, M. et al. Feasibility of Cervical Cancer Screening Utilizing Self-sample Human Papillomavirus Testing Among Mexican Immigrant Women in Harris County, Texas: A Pilot Study. J Immigrant Minority Health 17, 704–712 (2015). https://doi.org/10.1007/s10903-014-0125-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-014-0125-5

Keywords

Search

Navigation