Self-Collection for Cervical Screening Programs: From Research to Reality

Abstract

In 2018, there were an estimated 570,000 new cases of cervical cancer globally, with most of them occurring in women who either had no access to cervical screening, or had not participated in screening in regions where programs are available. Where programs are in place, a major barrier for women across many cultures has been the requirement to undergo a speculum examination. With the emergence of HPV-based primary screening, the option of self-collection (where the woman takes the sample from the vagina herself) may overcome this barrier, given that such samples when tested using a PCR-based HPV assay have similar sensitivity for the detection of cervical pre-cancers as practitioner-collected cervical specimens. Other advantages of HPV-based screening using self-collection, beyond the increase in acceptability to women, include scalability, efficiency, and high negative predictive value, allowing for long intervals between negative tests. Self-collection will be a key strategy for the successful scale up of cervical screening programs globally in response to the WHO call for all countries to work towards the elimination of cervical cancer as a public health problem. This review will examine self-collection for HPV-based cervical screening including the collection devices, assays and possible routine laboratory processes considering how they can be utilized in cervical screening programs.

Effect of telephone-based health education intervention models on cervical cancer screening compliance

“…In 2018, there were an estimated 570,000 new cases of cervical cancer on a global scale, most of them occurring with women who either had no access to cervical screening, or had not participated in screening in regions where the program is available. [ 13 ] Evidence-based medical surveys show that screening is an effective means for the prevention and treatment of cervical cancer. [ 14 ] Early diagnoses and standardized treatments of cervical cancer and its precancerous lesions can effectively reduce the incidence and mortality of cervical cancer.…”

Cervical screening during the COVID-19 pandemic: optimising recovery strategies

“…Few device or assay combinations are designed for medium-to-high throughput testing, meaning that their processing is more labour-intensive and time-consuming than is the processing of clinician-taken samples. 52 Thus, even in programmes that have already switched to HPV testing, a large-scale roll-out of self-sampling would require infrastructure that most programmes do not have readily available. Additionally, triage is required for women who are HPV-positive, and, at present, there are no clinically validated molecular biomarkers that could expedite triage on a self-sample.…”

“…These caveats suggest that self-sampling might not be a realistic strategy to rapidly scale up during this pandemic; however, it is certainly a promising option for the future. 52 …”

“…These caveats suggest that self-sampling might not be a realistic strategy to rapidly scale up during this pandemic; however, it is certainly a promising option for the future. 52 An important caveat to the COVID-19 responses considered here is that they are considered in a highincome country context. Low-income and middle-income countries typically do not have the advantage of highquality, population-wide cervical screening programmes supported by screening databases.…”

Human Papillomavirus and Cancers

“…The HPV testing in self-sampled cervical exfoliates has been shown to increase the participation of women in oncological screenings particularly in never- or under-screened populations. Hawkes et al, in their review, discussed several studies that have examined the self-collection of cervical samples for HPV-based cervical screening including the collection devices and assays [ 26 ]. The authors concluded that self-collection will be crucial for global screening programs and the elimination of cervical cancer as a public health problem.…”