Self-collected cervicovaginal sampling for site-of-care primary HPV-based cervical cancer screening: a pilot study in a rural underserved Greek population

Abstract

In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas HPV Test, Roche, HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs

“…In a study of 20,000 women from low-income communities in France, where low compliance with recommended Pap smear screening leads to 3,000 new cases of cervical cancer and 1,000 deaths each year, only 2% of women underwent Pap testing, while 18.3% of women responded to an invitation for a self-collected specimen for HPV testing ( 69 ). A study involving 346 women from underserved rural areas of Northern Greece, of whom only 17.1% had been regularly participating in Pap smear screening, found that 100% were willing to self-sample, with 90% willing to self-sample regularly if this option was available ( 70 ). First Nations women in Canada have a sixfold higher incidence of cervical cancer due to lower participation rates in cervical cancer programs; in a pilot program among 49 First Nations women, self-sampling was well received and the quality of samples was excellent ( 71 ).…”

Self-Sampling as a Plausible Alternative to Screen Cervical Cancer Precursor Lesions in a Population with Low Adherence to Screening: A Systematic Review

“…Therefore, it was clear that the majority of women preferred self-sampling over physician sampling. Studies in rural areas where there is limited access to health institutions such as those reported by Esber et al [9] and Chatzistamatiou et al [12], for example, reinforce the preference for self-sampling, with over 60 and 86.6% of women expressing primacy for this method, respectively.…”

“…(11) Were outcome measures (dependent variables) clearly defined, valid, reliable, and consistently implemented across all study participants? (12) Were the study evaluators blinded to the participants' exposure status? (13) Was the follow-up loss after baseline 20% or less?…”

“…(14) Were the main potential confounders measured and statistically adjusted for their impact on the relationship between exposure and outcome? [3] moderate to high Possati-Resende [10] moderate to high Haguenoer [1] high Allende [19] moderate to high Maza [11] moderate to high Esber [9] moderate Gottschlich [23] moderate Laskow [13] moderate Mbatha [14] moderate El-Zein [8] moderate Poli [16] low to moderate Vahabi [7] moderate to high Stanczuk [17] moderate Winer [4] moderate Chatzistamatiou [12] moderate B Requirements for quality assessment of articles included in the CASP checklist systematic review for randomized controlled trials comprised: (1) Did the study address a clearly focused issue? (2) Has the designation of patients for treatment been randomized?…”

Self-Sampling for HPV Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs

“…Pap smear screening, found that 100% were willing to self-sample, with 90% willing to 250 self-sample regularly if this option was available (Chatzistamatiou et al 2017). First 251 Nations women in Canada have a six-fold higher incidence of cervical cancer due to 252 lower participation rates in cervical cancer programs; in a pilot program among 49 First 253 Nations women, self-sampling was well received and the quality of samples was 254 excellent (Zehbe et al 2011).…”