Diagnostic accuracy of menstrual blood for human papillomavirus detection in cervical cancer screening: a systematic review

Abstract

Globally, cervical cancer is the fourth most common cancer among females and a major public health problem in low-and middle-income countries (LMICs). There are several screening tests available for cervical cancer screening; however, due to a lack of organised screening facilities as well as factors such as low participation rates in screening programmes, many women die due to cervical cancer. To reach out to a large number of women, an easy, non-invasive and time-saving screening method is required. Evidence supports that cervical cancer screening with human papillomavirus deoxyribonucleic acid (HPV DNA) testing is the most effective technique for lowering the incidence and mortality associated with cervical cancer when compared to other screening methods. Furthermore, a small number of studies have reported that menstrual blood can be used as an alternative sample for HPV detection for cervical cancer screening. We have done a systematic review of the studies that have reported the diagnostic accuracy of menstrual blood to detect HPV. We found five studies in our literature search. The studies showed the diagnostic accuracy of menstrual blood in terms of sensitivity ranging from 82.8% to 97.7% and specificity ranging from 50.0% to 98.0% in cervical intraepithelial neoplasia or HPV infection detection. This review supports the use of menstrual blood as a screening tool for cervical cancer especially in LMICs where women are reluctant to participate in cervical cancer screening due to issues such as embarrassment and discomfort to test Review

Menstrual Blood as a Diagnostic Specimen for Human Papillomavirus Genotyping and Genital Tract Infection Using Next-Generation Sequencing as a Novel Diagnostic Tool

“…In the study performed by Wong et al in 2010, the sensitivity, specificity, PPV and NPV of HPV detection using MB were found to be 82.8%, 93.1%, 90.0% and 87.9%, respectively. A total of 558 women were recruited in that study [5,7]. We believe the difference in sensitivity and PPV between the two studies was the result of the small sample size in this study.…”

“…To the best of our knowledge, this is the first study using mNGS as a diagnostic tool with MB samples. Unlike previous studies which requested the patients to submit the whole used napkins in a zippered plastic bag to the laboratory for testing [5], the patients who participated in this study were instructed to collect MB on napkins with a collection foam swab only. The collection swab was then sent to the laboratory for genomic DNA extraction and further testing.…”

“…Based on the fact that MB carries the causative pathogens of GTIs and HPV when it passes through the genital tract during menstruation, we proposed to use MB as a non-invasive diagnostic specimen for HPV genotyping and GTI diagnosis. The advantages of using MB as a diagnostic specimen include (1) non-invasiveness of sample collection; (2) self-sampling is possible and (3) collection is simple and quick; and (4) easily performed by patients in private without any embarrassment during sample collection process [5]. Hence, the use of MB as a diagnostic specimen is suitable for all women who menstruate.…”