Feasibility of self-sampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest Ontario, Canada: a pilot study

Abstract

BackgroundThe incidence of cervical cancer is up to sixfold higher among First Nation women in Canada than in the general population. This is probably due to lower participation rates in cervical cancer prevention programmes.ObjectiveTo raise screening participation in this underserved population by launching an alternative approach to (Pap)anicolaou testing in a clinic—namely, vaginal self-sampling followed by human papillomavirus (HPV) diagnostics.MethodsGood relationships were established with a First Nation community of the Northern Superior region in Northwest Ontario, and then 49 community women, aged 25–59, were recruited, who provided a vaginal self-sample and answered a questionnaire. Frequency distributions and cross-tabulations were used to summarise the data. Associations between categorical variables were assessed using the χ2 test of association, or the Goodman–Kruskal γ if both variables had ordered categories. Self-collected samples were tested for integrity and HPV using optimised molecular biological methods.ResultsThe majority of participants (87.2%) were amenable to future HPV screening by self-sampling. This finding was independent of age, educational level and a previous history of abnormal Pap tests. Interestingly, the preferred way to learn about sexual health remained through interaction with healthcare professionals. As defined by the presence of a housekeeping gene, self-sample integrity was high (96%). Using polymerase chain reaction-based Luminex typing, the overall HPV positivity was 28.6% (ie, with either a low- or high-risk type) and 16.3% were infected with a high-risk type such as HPV16.ConclusionIn this pilot study of First Nation women, self-sampling and HPV testing was well received and self-sample quality was excellent. A larger survey to be conducted in other Northern Superior communities in Northwest Ontario will determine whether this approach could become a viable screening strategy for First Nation women.

A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women

“…As demonstrated in previous studies (Ogilvie et al, 2007;Zehbe et al, 2011), there is emerging evidence that self-sampling may indeed be acceptable to Aboriginal women as well as other women who were less likely to attend Pap tests in the past. The HPV self-test can be conveniently and privately administered in a woman's home, but under current health policy, this test is not financially covered by the health care system.…”

Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study

“…This could lead to a more positive attitude towards sexual health and may have a beneficial outcome for cervical screening attendance (van Herk et al, 2010(van Herk et al, -2011. The prospects of offering self-collected vaginal samples to First Nations' women as an alternative to Pap cytology Zehbe et al, 2011), thus allowing them to conveniently take their own sample at home, was favourably acknowledged. Self-sampling for HPV would also eliminate other screening barriers such as long distance to the nearest health centre as well as lack of transportation and child care facilities (Maar et al, 2013).…”

“…Moreover, our pilot study with one partner community has shown that close to 90% of the women would prefer self-sampling over Pap testing (Zehbe et al, 2011). For a number of HCPs interviewed, the idea of HPV testing through self-sampling was appealing and would not compromise their relationship with their patients.…”

“…The Anishinaabek Cervical Cancer Screening Study (ACCSS) , was initiated as a pilot study in 2009 by the principal investigator (IZ), a non-Indigenous cancer biologist, to address inequities in cervical cancer screening and outcomes Zehbe et al, 2011). Following Ermine's (2007) principles of ethical space to develop a meaningful dialogue across cultural difference, IZ worked with First Nations leaders and health representatives from 10 Robinson Superior Treaty communities in Northwestern Ontario, Canada, to define project priorities and parameters and optimal ways to actively engage community members (Zehbe, Maar, Nahwegahbow, Berst, & Pintar, 2012).…”

“…This work, which is based on 16 interviews with health care professionals and 8 community focus groups with a total of 69 lay women participants, is part of a larger public health initiative currently underway with First Nations women in Northwestern Ontario to develop culturally sensitive approaches to cervical cancer screening and to explore the feasibility of self-sampling for HPV as an alternative screening modality to Pap cytology Zehbe et al, 2011).…”