Acceptability and Feasibility of HPV Self-Sampling as an Alternative Primary Cervical Cancer Screening in Under-Screened Population Groups: A Cross-Sectional Study

Abstract

Background: Cervical cancer is one of the most common cancers in women and about 90% of cervical cancer can be reduced by regular screening. The Pap smear has been well in place as a primary cervical screening method since 1950s; however, coverage is still not optimal. This study explored the feasibility of HPV self-sampling in two under-screened population groups in Hong Kong (HK): never screened and not regularly screened females, to estimate the uptake rate and preference rate in the future. Materials and Methods: This was a cross-sectional study to explore the acceptability and feasibility of HPV self-sampling in two age groups: aged 25–35 and aged ≥45, which were reported as the highest proportion of the under-screened population in HK between 2017 and 2018. The study invited eligible women from an HPV study cohort to perform HPV self-sampling at home by themselves. The number of specimens returned from participants was recorded and used to determine the feasibility of HPV self-sampling in the community. The participants were asked to fill in the questionnaires before and after HPV self-sampling to indicate their attitudes, acceptability, and future preference for HPV self-sampling as an acceptable alternative primary cervical cancer screening method. Results: A total of 177 subjects participated in the present study and have achieved a good overall uptake rate of 73% (129/177) who returned the self-collected cervicovaginal sample for HPV testing. Among the under-screened population, there was a higher response rate in aged ≥45 than those aged 25–35. The findings also revealed that women who were under-screened, including those who have never been screened, were more likely to prefer HPV self-sampling than those who had regular screening. This study found that the acceptability of HPV self-sampling was fairly positive among the respondents. The findings also indicated that HPV self-sampling was not only beneficial to enhance their health awareness but also to promote the cervical cancer screening uptake rate, especially among the under-screened or never screened populations. Conclusions: HPV self-sampling would be a solution to overcome the perceived barriers in clinician-based screening. The findings also indicated that it could be feasible to use as an alternative primary cervical cancer screening.

Human Papillomavirus Self-Sampling for Primary Cervical Cancer Screening in Under-Screened Women in Hong Kong during the COVID-19 Pandemic

“…Nonetheless, the acceptability of self-sampling is highly variable among different settings, social backgrounds and age groups [ 20 , 21 ]. In our study, women in the older age group were significantly less confident in performing self-sampling compared to the younger age group, which contrasts with another local study where the confidence was similar among younger and older age groups [ 17 ]. One potential reason is that the women in the older age group may have experienced conventional smears previously and feel more confident with clinician sampling.…”

“…We found that 89.2% of the under-screened women in our study were willing to have self-sampling again, as it can be asserted that obtaining a sample in the privacy of one’s own home may eliminate some of the factors that currently deter women from attending cervical screenings. Self-sampling is recognised as an easy, convenient collection method, with most participants being confident with the procedure and having a positive experience and minor discomfort, as found in several studies [ 17 , 18 , 19 ] including ours. Nonetheless, the acceptability of self-sampling is highly variable among different settings, social backgrounds and age groups [ 20 , 21 ].…”

The Acceptance of Human Papillomavirus Self-Sampling Test among Muslim Women:A Systematic Review

“…As HPV self-sampling test necessitates women performing the test themselves, it is thus critical that they feel confident in doing so. Participants in previous studies who took the HPV test stated that it was a userfriendly and straightforward test; thus, they felt confident and preferred it to cytology testing (Murchland et al, 2019;Wong et al, 2020). However, in this review, three included studies mentioned that Muslim women felt less confident in doing the test (Lofters et al, 2017;Abdullah et al, 2018;Afzal et al, 2020).…”

A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities

“…Self-sampling as an alternative method of screening can overcome barriers, such as access to the health facility and fear associated with pelvic examination, opening new possibilities of reaching underscreened women (112). Acceptability of selfsampling has been reported across cultures and resource-settings (113)(114)(115)(116)(117). HPV self-sampling has the potential to make HPV testing more affordable and cost-effective by increasing screening coverage (118).…”