HPV self-sampling or the Pap-smear: A randomized study among cervical screening nonattenders from lower socioeconomic groups in France

Abstract

5 ECCA (European cervical cancer association) Brussels, Belgium Today in France, low attendance to cervical screening by Papanicolaou cytology (Pap-smear) is a major contributor to the 3,000 new cervical cancer cases and 1,000 deaths that occur from this disease every year. Nonattenders are mostly from lower socioeconomic groups and testing of self-obtained samples for high-risk Human Papilloma virus (HPV) types has been proposed as a method to increase screening participation in these groups. In 2011, we conducted a randomized study of women aged 35-69 from very low-income populations around Marseille who had not responded to an initial invitation for a free Pap-smear. After randomization, one group received a second invitation for a free Pap-smear and the other group was offered a free self-sampling kit for HPV testing. Participation rates were significantly different between the two groups with only 2.0% of women attending for a Pap-smear while 18.3% of women returned a self-sample for HPV testing (p 0.001). The detection rate of high-grade lesions ( CIN2) was 0.2& in the Pap-smear group and 1.25& in the self-sampling group (p 5 0.01). Offering self-sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions ( CIN2) in comparison to the group of women receiving a second invitation for a Pap-smear. However, low compliance to follow-up in the self-sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.Cervical cancer screening with Papanicolaou cytology (Papsmear) has markedly decreased cervical cancer rates in those high-income countries where it has been effectively implemented. In France, from 1980 to 2009, age standardized incidence rates (world population) decreased from 14.9 to 6.4/ 100,000, while cervical cancer mortality decreased from 5.4 to 1.7/100,000. 1 Irregular or nonattendance to screening is the principal cause of the 3,000 new cervical cancers diagnosed annually in France today and which lead to 1,000 deaths each year. Various studies show that 60-65% of women diagnosed with invasive cervical cancer have not been regularly screened. 2 In France, cervical screening is opportunistic but the widespread availability of services combined with cultural factors has led to good coverage of the target population and irregular or nonattenders are now mostly from lower socioeconomic groups or women over the age of 55 years with cultural barriers toward clinical gynecological examination. 3,4 One project to increase the participation rate in these groups introduced an organized screening process for women living in the northern suburbs of Marseille (France) where the majority are immigrants living on low incomes. In 2001, women with no Pap-smears recorded during the past 2 years were sent a personal letter inviting them to consult their general practitioner for a free Pap-smear but only 1.8% of the women participated. In 2003, the process was repeated with women invited to have a free Pap-sm...

Human papillomavirus (HPV) testing on self-collected specimens: perceptions among HIV positive women attending rural and urban clinics in South Africa

“…Because it is known that under-screened women are at increased risk of cervical cancer, targeting non-attendees of the screening program could improve the effectiveness of cervical screening [31, 32]. Non-attendees are mostly from lower socioeconomic groups and self-testing has shown to facilitate access to cervical screening for women in low-resource areas [32].…”

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

“…In countries with publicly funded cervical cancer screening programs, irregular attendance or non-attendance to screening is one of the key barriers to further reducing cervical cancer rates 19,20 . Lower screening rates have been reported in specific populations, such as immigrant women, women of low socio-economic status, and Indigenous women 21,22 .…”

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

“…Self-sampling is a method to collect cervical specimen by using a special designated device to collect cervical cells at squamouscolumnar junction by the user themselves without assistance of medical personnel. Studies have shown that using self-sampling method increases participation of non-responders in screening programs (Bosgraaf et al, 2014a;Piana et al, 2011;Sancho-Garnier et al, 2013). Self-sampling samples have also been shown to be suitable for HPV testing (Sancho-Garnier et al, 2013;Scarinci et al, 2013;Tamalet et al, 2013;Othman and Othman, 2014) even in a in a large-scale (Harper et al, 1999).…”

“…The use of self-sampling may lead to higher acceptability to screening (Gok et al, 2012a;Wikstrom et al, 2011). Self-sampling is more attractive for the non-attendees in countries which have organized screening and from rural women in countries which have limited resources (Sancho-Garnier et al, 2013). It can be an alternative method to women who are reluctant to undergo pelvic examination due to shyness (Scarinci et al, 2013) or too busy looking after the family which is often the case amongst Asian women (Othman and Rebolj, 2009).…”