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Canadian Journal of Public Health

, Volume 104, Issue 2, pp e159–e166 | Cite as

Self-collected HPV Testing Improves Participation in Cervical Cancer Screening: A Systematic Review and Meta-analysis

  • C. Sarai RaceyEmail author
  • Diana R. Withrow
  • Dionne Gesink
Systematic Review
  • 2 Downloads

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-totreat 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.

Key Words

Human papillomavirus cervical cancer screening self collected specimens under-screening review 

Résumé

Objectif: Le test du VPH se montre efficace pour dépister le cancer du col utérin. Le recours à l’autotest du VPH pourrait potentiellement surmonter un bon nombre des obstacles au dépistage et joindre les femmes à risque en les faisant participer au dépistage. Il faut cependant examiner les preuves pour voir si le fait d’offrir l’autotest du VPH augmente en pratique le recours au dépistage. Nous avons cherché à déterminer dans quelle mesure le fait d’offrir l’autotest du VPH augmente le recours au dépistage chez les femmes qui ne sont jamais ou qui sont insuffisamment examinées pour le cancer du col utérin.

MÉTHODE: Une revue systématique de la littérature spécialisée dans les bases de données Medline et Embase a permis de recenser les articles traitant de l’utilisation de l’autotest du VPH pour dépister le cancer du col utérin. Nous avons effectué une méta-analyse à l’aide d’un modèle à effets aléatoires pour calculer la conformité relative, avec une analyse en intention de traiter de l’autotest du VPH comparativement au dépistage par frottis de Papanicolaou, avec des intervalles de confiance (IC) de 95 %. Tous les tests statistiques étaient bilatéraux.

Synthèse: Dix études ont été examinées dont huit européennes et deux nord-américaines. Sur les 10 études, neuf employaient un plan d’étude aléatoire. Dans toutes les études, la conformité relative de l’autotest du VPH par rapport au frottis était significativement plus élevée que 1,0 (p<0,01). La conformité relative globale était de 2,14 (IC de 95 %: 1,30–3,52). La conformité au dépistage était très hétérogène d’une étude à l’autre, tant pour l’autotest du VPH que pour le dépistage par frottis.

CONCLUSION: L’autotest du VPH améliorait significativement la participation des femmes qui n’avaient pas systématiquement recours aux programmes de dépistage du cancer du col utérin. De nouvelles approches de prestation de l’autotest du VPH devraient être envisagées à mesure que l’intégration du test du VPH en tant qu’outil de dépistage primaire se généralise.

Mots Clés

papillomavirus humain dépistage du cancer du col utérin échantillons auto-prélevés sous-dépistage examen 

References

  1. 1.
    Gustafsson L, Ponten J, Zack M, Adami, HO. International incidence rates of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control 1997;86(5):755–63.Google Scholar
  2. 2.
    Decker K, Demers A, Chateau D, Musto G, Nuget Z, Lotocki R, Harrison M. Papanicolaou test utilization and frequency of screening opportunities among women diagnosed with cervical cancer. Open Med 2009;3(3):140–47.Google Scholar
  3. 3.
    Black AT, McCulloch A, Martin RE, Kan L. Young women and cervical cancer screening: What barriers persist? Can J Nurs Res 2011;43(1):8–21.PubMedGoogle Scholar
  4. 4.
    Redwood-Campbell L, Fowler N, Laryea S, Howard M, Kaczorowski J. ‘Before you teach me, I cannot know’: Immigrant women’s barriers and enablers with regard to cervical cancer screening among different ethnolinguistic groups in Canada. Can J Public Health 2011;102(3):230–34.Google Scholar
  5. 5.
    Waller J, Jackowska M, Marlow L, Wardle J. Exploring age differences in reasons for nonattendance for cervical screening: A qualitative study. BJOG 2012;119(1):26–32.PubMedGoogle Scholar
  6. 6.
    Logan L, McIlfatrick S. Exploring women’s knowledge, experiences and perceptions of cervical cancer screening in an area of social deprivation. Eur J Cancer Care (Engl) 2011;20(6):720–27.Google Scholar
  7. 7.
    Brown DR, Wilson RM, Boothe MAS, Harris CES. Cervical cancer screening among ethnically diverse black women: Knowledge, attitudes, beliefs, and practices. J Natl Med Assoc 2011;103(8):719–28.PubMedGoogle Scholar
  8. 8.
    Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189(1):12–19.PubMedGoogle Scholar
  9. 9.
    Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012;137(4):516–42.PubMedGoogle Scholar
  10. 10.
    Petignat P, Vassilakos P. Is it time to introduce HPV self-sampling for primary cervical cancer screening? J Natl Cancer Inst 2012;104(3):166–67.PubMedGoogle Scholar
  11. 11.
    Agorastos T, Sotiriadis A, Chatzigeorgiou K. Can HPV testing replace the pap smear? Ann N Y Acad Sci 2010;1205:51–56.PubMedGoogle Scholar
  12. 12.
    Bhatla N, Dar L, Patro AR, Kumar P, Kriplani A, Gulati A, et al. Can human papillomavirus DNA testing of self-collected vaginal samples compare with physician-collected cervical samples and cytology for cervical cancer screening in developing countries? Cancer Epidemiol 2009;33(6):446–50.PubMedGoogle Scholar
  13. 13.
    Schiffman M, Wentzensen N, Wacholder S, Kinney W, Gage JC, Castle, PE. Human papillomavirus testing in the prevention of cervical cancer. J Natl Cancer Inst 2011;103(5):368–83.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Wright TC, Jr. Cervical cancer screening in the 21st Century: Is it time to retire the PAP smear? Clin Obstet Gynecol 2007;50(2):313–23.PubMedGoogle Scholar
  15. 15.
    Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla Palma P, Del Mistro A, et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: A randomized controlled trial. Lancet Oncology 2010;11:249–57.PubMedGoogle Scholar
  16. 16.
    Leinonen M, Nieminen P, Kotaniemi-Talonen L, Malila N, Tarkkanen J, Laurila P, 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.PubMedGoogle Scholar
  17. 17.
    Mayrand M-H, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med 2007;357(16):1579–88.PubMedGoogle Scholar
  18. 18.
    Karwalajtys T, Howard M, Sellors JW, Kaczorowski J. Vaginal self sampling versus physician cervical sampling for HPV among younger and older women. Sex Transm Infect 2006;82(4):337–39.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Ogilvie GS, Patrick DM, Schulzer M, Sellors JW, Petric M, Chambers K, 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.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Petignat P, Faltin DL, Bruchim I, Tramer MR, Franco EL, Coutlee F. Are selfcollected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis. Gynecol Oncol 2007;105(2):530–35.PubMedGoogle Scholar
  21. 21.
    Moscicki AB, Widdice L, Ma Y, Farhat S, Miller-Benningfield S, Jonte J, et al. Comparison of natural histories of human papillomavirus detected by clinician- and self-sampling. Int J Cancer 2010;127(8):1882–92.Google Scholar
  22. 22.
    Huynh J, Howard M, Lytwyn A. Self-collection for vaginal human papillomavirus testing: Systematic review of studies asking women their perceptions. J Low Genit Tract Dis 2010;14(4):356–62.PubMedGoogle Scholar
  23. 23.
    Igidbashian S, Boveri S, Spolti N, Radice D, Sandri MT, Sideri M. Self-collected human papillomavirus testing acceptability: Comparison of two selfsampling modalities. J Womens Health (Larchmt) 2011;20(3):397–402.Google Scholar
  24. 24.
    Wikstrom I, Stenvall H, Wilander E. Attitudes to self-sampling of vaginal smear for human papilloma virus analysis among women not attending organized cytological screening. Acta Obstet Gynecol Scand 2007;86(6):720–25.PubMedGoogle Scholar
  25. 25.
    Zehbe I, Moeller H, Severini A, Weaver B, Escott N, Bell C, et al. Feasibility of self-sampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest Ontario, Canada: A pilot study. BMJ Open 2011;1(1):e000030–e.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Ogilvie G, Krajden M, Maginley J, Isaac-Renton J, Hislop G, Elwood-Martin R, et al. Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women. CMAJ 2007;177(5):480–83.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Schmeink CE, Bekkers RL, Massuger LF, Melchers, WJ. The potential role of self-sampling for high-risk human papillomavirus detection in cervical cancer screening. Rev Med Virol 2011;21(3):139–53.PubMedGoogle Scholar
  28. 28.
    Zhao FH, Lewkowitz AK, Chen F, Lin MJ, Hu SY, Zhang X, et al. Pooled analysis of a self-sampling HPV DNA test as a cervical cancer primary screening method. J Natl Cancer Inst 2012;104(3):178–88.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377–84.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Higgins JPT, Thompson SG, Deeks JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–60.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Bais AG, van Kemenade FJ, Berkhof J, Verheijen RH, Snijders PJ, Voorhorst F, 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.Google Scholar
  32. 32.
    Gok M, Heideman DAM, van Kemenade FJ, Berkhof J, Rozendaal L, Spruyt JWM, 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:c1040. doi: 10.1136/bmj.c1040.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Gok M, van Kemenade FJ, Heideman DA, Berkhof J, Rozendaal L, Spruyt JW, 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.PubMedGoogle Scholar
  34. 34.
    Giorgi Rossi P, Marsili LM, Camilloni L, Iossa A, Lattanzi A, Sani C, 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.Google Scholar
  35. 35.
    Szarewski A, Cadman L, Mesher D, Austin J, Ashdown-Barr L, Edwards R, 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.PubMedPubMedCentralGoogle Scholar
  36. 36.
    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):337–39.PubMedPubMedCentralGoogle Scholar
  37. 37.
    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(9):1960–69.PubMedGoogle Scholar
  38. 38.
    Piana L, Leandri FX, Le Retraite L, Heid P, Tamalet C, Sancho-Garnier H. L’auto-prélèvement vaginal à domicile pour recherche de papilloma virus à haut risque. Campagne expérimentale du département des Bouches-du- Rhône. Bulletin du Cancer 2011;98(7):723–31.PubMedGoogle Scholar
  39. 39.
    Lazcano-Ponce E, Lorincz AT, Cruz-Valdez A, Salmeron J, Uribe P, Velasco-Mondragon E, 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.PubMedGoogle Scholar
  40. 40.
    Castle PE, Rausa A, Walls T, Gravitt PE, Partridge EE, Olivo V, et al. Comparative community outreach to increase cervical cancer screening in the Mississippi Delta. Prev Med 2011;52(6):452–55.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Edwards JB, Tudiver F. Women’s preventive screening in rural health clinics. Womens Health Issues 2008;18(3):155–66.PubMedGoogle Scholar
  42. 42.
    Fehringer G, Howlett R, Cotterchio M, Klar N, Majpruz-Moat V, Mai V. Comparison of papanicolaou (Pap) test rates across Ontario and factors associated with cervical screening. Can J Public Health 2005;96(2):140–44.PubMedGoogle Scholar
  43. 43.
    Yabroff KR, Lawrence WF, King JC, Mangan P, Washington KS, Yi B, et al. Geographical disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment. J Rural Health 2005;21(2):149–57.PubMedGoogle Scholar
  44. 44.
    Nene B, Jayant K, Arrossi S, Shastri S, Budukh A, Hingmire S, et al. Determinants of women’s participation in cervical cancer screening trial, Maharashtra, India. Bull WHO 2007;85(4):264–72.PubMedGoogle Scholar
  45. 45.
    Sankaranarayanan R, Nene BM, Dinshaw KA, Mahe C, Jayant K, Shastri SS, et al. A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India. Int J Cancer 2005;116(4):617–23.PubMedGoogle Scholar
  46. 46.
    Sowjanya AP, Paul P, Vedantham H, Ramakrishna G, Vidyadhari D, Vijayaraghavan K, et al. Suitability of self-collected vaginal samples for cervical cancer screening in Periurban Villages in Andhra Pradesh, India. Cancer Epidemiol Biomarkers Prev 2009;18(5):1373–78.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Lindell M, Sanner K, Wikstrom I, Wilander E. Self-sampling of vaginal fluid and high-risk human papillomavirus testing in women aged 50 years or older not attending Papanicolaou smear screening. BJOG 2012;119(2):245–48.Google Scholar
  48. 48.
    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):871–74.Google Scholar
  49. 49.
    Stenvall H, Wikstrom I, Wilander E. High prevalence of oncogenic human papilloma virus in women not attending organized cytological screening. Acta Derm Venereol 2007;87(3):243–45.PubMedGoogle Scholar

Copyright information

© The Canadian Public Health Association 2013

Authors and Affiliations

  • C. Sarai Racey
    • 1
    Email author
  • Diana R. Withrow
    • 1
  • Dionne Gesink
    • 1
  1. 1.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada

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