Dry self-sampling versus provider-sampling of cervicovaginal specimens for human papillomavirus detection in the Inuit population of Nunavik, Quebec

Abstract

Objective To assess the comparability of self-collected cervicovaginal samples and provider-collected cervical samples for the detection of human papillomavirus (HPV) DNA among Inuit women in Nunavik, Quebec, avoiding the use of liquid-based storage and transport of the self-collected samples. Methods Ninety-three women aged 18–69 years were recruited from a previously formed cohort on the natural history of HPV to this cross-sectional measurement study. This study utilized HPV DNA test results from 89 paired specimens collected by study participant and health provider with Dacron swabs. Samples were tested for 36 HPV types with the PGMY-primer PCR protocol and genotyping with the linear array method. Unweighted kappa statistics and McNemar tests were used to measure the agreement between sampling techniques. Results In the self-collected samples, 30 different HPV types were found, compared with 29 types found in the provider-collected samples. The prevalence of high-risk (HR) HPV was 38.2% in the self-collected samples and 28.1% in the provider-collected samples. The agreement between collection methods for the detection of HR-HPV DNA (85.4%) was good. HR-HPV and type-specific HPV 16/18 were as likely to be detected in the self-collected samples compared with the provider-obtained samples. Conclusions Women in this population were easily able to collect adequate cervicovaginal specimens for HPV testing. As self-sampling has a high recovery of HR-HPV and is comparable with provider-sampling, we conclude that self-sampling with dry storage and transport could be a good cervical cancer screening alternative for Inuit women in Nunavik who have traditionally avoided speculum examination.

Self-Collection Tools for Routine Cervical Cancer Screening: A Review

“…The most commonly used brand for swab self-sampler is Dacron swab or cotton swab (Moscicki et al, 2010;Cerigo et al, 2012;Karwalajtys et al, 2006;Gravitt et al, 2001). It is small, easy to use and can be processed in a similar technique as to those collected by physicians (Zehbe et al, 2011).…”

“…Self-sampling with a cotton tip swab can miss 50% more cancers than physician sampling, indicating that the cotton tip technique is not a safe method for the collection of samples aimed at primary cervical cancer screening (Lorenzato et al, 2002). The majority of studies using Dacron swab have used liquid-based storage and transport which is impractical because the fluid may leak (Cerigo et al, 2012). Moreover, the swabs need to be kept in cold box until the sample is sent to the lab for processing (Forney et al, 2010).…”

“…Previous studies have examined the sensitivity and predictive value of HPV detection by comparing self-collected and clinician collected samples for HPV testing (Cerigo et al, 2012;da Silva Rocha et al, 2012). Studies have shown that self-sampling yields more often HPV-positive results compared to physician-collected samples (Cerigo et al, 2012).…”

“…Studies have shown that self-sampling yields more often HPV-positive results compared to physician-collected samples (Cerigo et al, 2012). It can also be an additional method instead of only conventional cytology screening which often is associated with sampling, processing and screening error (Schmeink et al, 2011).…”

“…However, the use of self-sampling device without any of these also shows good results (Cerigo et al, 2012;Darlin et al, 2013).…”