The Utility of Urine-Based Sampling for Cervical Cancer Screening in Low-Resource Settings

Abstract

Background:WHO has recommended Visual Inspection with Acetic acid (VIA) or Human Papillomavirus (HPV) DNA testing if feasible, for cervical cancer screening in low income countries. However, the number of women undergoing screening is very low as a result of limited information, inadequate infrastructure and invasive nature of sampling. Methods:A cross sectional study was carried out comparing HPV DNA detection by Polymerase Chain Reaction (PCR) in paired cervical and urine samples procured from histologically confirmed cervical cancer cases. Results:Amongst the samples collected from 114 cervical cancer cases, HPV DNA was tested positive in cervical samples of 89 (78.1%) and urine samples of 55 (48.2%) patients. The agreement between the two sampling methods was 66.7% and the kappa value was 0.35 indicating a fair agreement. The sensitivity of HPV detection using urine samples was 59.6% (95% confidence interval 49.16%-69.15%) and the specificity was 92% (95% confidence interval 75.0%-97.8%). Conclusion:Even though not acceptable as an HPV DNA screening tool due to low sensitivity, the urine sampling method is inexpensive and more socially acceptable for large epidemiological surveys in developing countries to estimate the burden.

Comparison of two self‐sampling methods for human papillomavirus (HPV) DNA testing among women with high prevalence rates

“…Even though urine samples will be more acceptable to women, further optimization in the collection of urine samples is needed and urine samples can be employed for large epidemiological studies in low resource settings. 18 Very few studies compared HPV detection in self-collected urine and vaginal samples globally. 15,16,19,20 Urine self-sampling is more acceptable to nonresponders and is preferred for virological surveillance after HPV vaccination among adolescents.…”

“…This may lead to a paradigm shift in screening strategy from cytology or cotesting to HPV DNA testing alone as in many European countries. Even though urine samples will be more acceptable to women, further optimization in the collection of urine samples is needed and urine samples can be employed for large epidemiological studies in low resource settings 18 . Very few studies compared HPV detection in self‐collected urine and vaginal samples globally 15,16,19,20 .…”

Performance of an affordable urine self-sampling method for human papillomavirus detection in Mexican women

“…Current screening programs, in these settings, have low coverage, being 59.7% in Mexico, and even lower in other countries [2,3]. Cervical screening requires trained personnel and infrastructures to collect cervical samples, which is not always available in LMICs [4][5][6]. Furthermore, cultural background alone can act as a barrier to achieving high screening coverage when patients' acceptance of pelvic examination is low [4,5].…”

“…Urine self-sampling has been proposed as an alternative primary screening method for detecting high-risk human papillomavirus (hrHPV), given self-sampling may increase women's willingness to participate in screening [3][4][5]. Previous studies have used specially designed collection devices with specialized buffers and preservation media, which are costly [7,8], hindering implementation of urine sampling for hrHPV screening in LMICs, where it is most needed [1,6].…”

“…The funders had no role in study design, data collection and analysis, decision to publish, or preparation and revision of the manuscript. overcome barriers that limit screening coverage [4,5,15]. It is also important to evaluate the acceptability of urine self-collection among participants of the targeted cervical cancer screening program, among health professionals involved in the program and decision-makers of healthcare-services who are responsible for potential implementation of this procedure within the cervical cancer screening program.…”