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Home samples for cervical screening tests could boost uptake

Women missing screening appointments could use self-sampling kits

Adrian O'Dowd

Thursday, 06 December 2018

Women failing to respond to cervical cancer screening invitations could be sent kits and asked to take their own sample at home so these can be sent to a laboratory for testing, suggests a study* published today in The BMJ.

Self-sampling kits could also be given to women in countries that do not have formal screening programmes, such as developing countries in Africa and South America.

Testing for high-risk human papillomavirus (HPV) infection is replacing cytology as the screening test for cervical cancer and women who do not attend cervical screening appointments will often provide a sample if they are sent a self-sampling kit.

Most cervical cancer cases occur in women who have never been screened for cervical cancer, or do not participate regularly in routine screening.

Cervical cancer rates have reduced in countries in Europe, North America, Australia and New Zealand in response to the introduction of widespread screening programmes.

However, incidence has not dropped to the same extent in areas such as Eastern Europe, where coverage is low or the quality of screening is not as good, and most cervical cancer cases occur in less developed countries.

Figures* from NHS Digital published last month showed cervical screening coverage in England fell and was now at just 71.4% for 2017-18 – a 21-year low.

An international team of researchers wanted to examine how self-sampling affected the accuracy of HPV testing and whether its use might improve cervical cancer detection among women not participating in screening programmes.

They conducted two systematic reviews of published trial results. The first review included 56 studies which assessed the accuracy of HPV testing on samples taken by the woman herself compared with those collected by a clinician.

It found that HPV tests based on a technology called polymerase chain reaction (PCR) were just as good at detecting cervical pre-cancer (CIN2+ or CIN3+) in samples taken by the woman herself as they were in samples taken by a clinician.

However, HPV tests based on a process called signal amplification were not as good on self-samples.

The review found that both types of HPV tests returned a slightly greater number of false positives when used on self-samples rather than samples taken by a clinician, meaning that a few more women who took their own samples would be told they have a positive screening test without presence of cervical precancer.

The second analysis included 25 trials comparing the impact of offering self-sampling kits instead of screening appointments to under screened women, including those who had not been attending previous screening appointments.

This showed that women who sent self-sampling kits were more than twice as likely to respond by providing a sample for testing than they were to respond to an invitation or reminder letter asking them to attend an appointment with a clinician to have a sample taken.

When women in developing countries without formal screening programmes were offered self-sampling kits at a home visit, more than 80% took up the offer.

For their study, the authors acknowledged that there was a lack of detailed data on potentially influential factors in the studies and that this might be overcome by pooling individual patient data from the best individual trials.

Use of self-sampling for HPV testing may increase coverage substantially, according to the authors who said: “The highest participation rates in our systematic review were observed in studies that included door-to-door invitation scenarios conducted in Latin America or Africa.

“However, the direct offer of a self-sampling kit by a health professional might also be an effective strategy to reach non-responders in countries with established screening programmes.”

*Arbyn, M; Smith, SB; Temin, S; et al, on behalf of the Collaboration on Self-Sampling and HPV Testing. Detecting cervical precancer and reaching under screened women by using HPV testing on self samples: updated meta-analyses. BMJ 2018;363:k4823. DOI:10.1136/bmj.k4823
**Cervical screening programme 2017-18 [NS]. NHS Digital, November 2018.

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