Comparison of cervical cancer screening by self-sampling papillomavirus test versus pap-smear in underprivileged women in France

Abstract

Background The purpose of this study was to compare cervical cancer screening by pap smear (PS) versus preliminary HPV testing based on self-collected samples (SC-HPV). Methods Interventional study among underprivileged women from 25 to 65 years old in four French cities. The control group (CG) was referred for a PS. The experimental group (EG) conducted a SC-HPV test followed by a PS in case of positivity. Differences on screening completion and cytological abnormalities were analysed by logistic and Cox regression. Results 383 women were assigned to the EG and 304 to the CG. The screening completion proportion was 39.5% in the CG compared to 71.3% in the EG (HR = 2.48 (CI 95% [1.99–3.08]; p < 0.001). The proportion of cytological abnormalities was 2.0% in the CG and 2.3% in the EG (OR = 1.20 (CI 95% [0.42–3.40]; p = 0.7). The proportion of participants lost to follow-up was 60.5% in the CG and 63.2% in the EG HPV positive (p = 0.18). Conclusion Providing an SC-HPV-test increased the participation of underprivileged women in CCS. Nevertheless, the significant number of lost to follow-up in both groups can undermine the initial benefits of the strategy for HPV positive women. Registration: Clinicaltrials.gov: NCT03118258.

Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature

“…A study in France ( 62 ) evaluated the impact of offering self-sampling CCS tests in a community disadvantaged due to factors such as low-income, low levels of education, and experience of homelessness and sub-standard housing. All women eligible and included in the study were offered an individual sexual and reproductive health consultation covering HPV infection, cervical cancer, and gynecological care and screening access information.…”

“…Invitations to screening need to be timely, culturally sensitive, and accessible (focusing on screening/cancer-specific information). Perhaps the best evidence relates to self-sampling for HPV, shown in many studies to be effective ( 59 , 62 , 70 – 72 ), especially for some populations disadvantaged by traditional programs. However, there is scarce evidence on how interventions can be integrated into existing healthcare systems or can enhance women’s ability to make informed decisions.…”

Acceptance of Self-Sampling by Women Not Regularly Participating in Cervical Cancer Screening in Areas with Low Medical Density: A Qualitative Study within the French CapU4 Trial

“…(12) Have you thought about follow-up after the results? (13) What would be the ideal post-test kit for you? (14) In your opinion, who would be the ideal referral professional for the screening of this cancer?…”

“…The clinical accuracy of HPV testing on VSS was investigated in the VALHUDES trial (VALidation of HUman papillomavirus assays and collection DEvices for Self-samples and urine samples), and one of the most often used and commercially available brushes for VSS is the FLOQSwabs ® vaginal self-sampling device (Copan Diagnostics, Brescia, Italy), a dry swab [ 11 , 12 ]. Furthermore, VSS represents an opportunity to reach under-screened women [ 13 , 14 ] and, moreover still, is better accepted by women, who generally prefer it to cervical-uterine sampling carried out by healthcare professionals [ 15 , 16 ]. Strangely though, only eight countries worldwide recommend VSS as a means of reaching under-screened populations [ 17 ].…”

Turning the tide—Recommendations to increase cervical cancer screening among women who are underscreened

“…109 Research needs include enhancing sample and workflow parameters to improve the accuracy of self-test results and identifying how to ensure successful follow-up testing after an initial positive HPV self-test. [99][100][101]110 Reducing the screening interval should also be considered as a potential mitigation for lower test accuracy.…”