Self-Sampling as a Plausible Alternative to Screen Cervical Cancer Precursor Lesions in a Population with Low Adherence to Screening: A Systematic Review

Abstract

Background: Cervical cancer is the fourth most common cancer in the world. A raised incidence and mortality parallel a low participation rate in screening, namely screening in poor countries and among specific populations of developed countries. Cervical or vaginal self-sampling may increase adherence to screening due to its low costs and elevated sensibility and specificity. Our main goal was to compare self-sampling with physician sampling and to evaluate the participation rate of women formerly non-adherent to cervical cancer screening. Study Design: We identified relevant studies from PubMed. Studies were eligible for inclusion if they fulfilled the following criteria: women aged between 16 and 80 years, poor and developed countries that use self-sampling, women with a low participation rate in screening and studies published since 2013. After fully reading the articles, data were extracted to an Excel sheet to ­display all relevant information in an organized manner. ­Results: We identified 18 studies, which altogether enrolled 22,118 women. Self-sampling and physician sampling are quite similar regarding the HPV detection rate. Women have a low participation rate mainly because of limited access to health services, religious and culture beliefs, and lack of time due to several demanding tasks in daily life. Self-sampling shows a significant increase in acceptability and preference compared to physician sampling. Conclusion: Self-sampling is a reliable method to involve women in opportunistic or organized screening programs for cervical cancer prevention.

The future of cancer screening after COVID‐19 may be at home

“…Based on the evidence for mt-sDNA testing and FIT, and the emerging findings regarding cervical self-screening, home-based patient screening is both accessible and acceptable to patients [18][19][20][21][22] across diverse Only completed visits that could be assigned to a specific provider were reported. Over time, visit types changed (eg, with the addition of a nurse practitioner care navigator).…”

“…Based on the evidence for mt‐sDNA testing and FIT, and the emerging findings regarding cervical self‐screening, home‐based patient screening is both accessible and acceptable to patients 18‐22 across diverse populations, reducing the embarrassment that often accompanies these tests in a medical office 23‐27 . There are cost differences, however.…”

Predictors of screening for cervical and colorectal cancer in women 50–65 years old in a multi-ethnic population

“…Currently, 72% of initial CRC screens are done by stool-based testing ( Wernli et al, 2014 ) with one of the following methods: the fecal occult blood test (FOBT), fecal immunochemical test (FIT), and multitarget stool DNA test (MT-sDNA test, or FIT-DNA) all of which are FDA approved, standard of care, and recommended specifically as a home test by the United States Preventive Services Task Force (USPSTF) ( Bibbins-Domingo et al, 2016 , Gupta et al, 2020 ). Cervical cancer screening through a primary HPV test is being fielded around the world as a means of reaching women who otherwise would not be screened ( Caleia et al, 2020 , Sahasrabuddhe et al, 2011 ), and home self -sampling kits are under evaluation for Food and Drug Administration (FDA) approval. In addition, we have seen the disruption in both cancer screening preventive services with an 86% decline in colorectal and 94% decline in cervical cancer screening nationally due to the coronavirus-19 (COVID-19) pandemic ( Health, 2020 ).…”

British Gynaecological Cancer Society recommendations and guidance on patient-initiated follow-up (PIFU)

“…It should be noted that the BSCCP recommends vault smears at 6 and 18 months after a hysterectomy for cervical intraepithelial neoplasia (CIN) 27 if margins are free of CIN. However, vaginal vault cytology should not be performed following treatment for FIGO stage ≥IA2 as it does not add significantly to the detection of recurrent disease 25, [27][28] . These patients have a 5-year risk of recurrence of 5.8-8% 27,[29][30][31] .…”

“…These patients have a 5-year risk of recurrence of 5.8-8% 27,[29][30][31] . However only 4-5% will have pelvic recurrences and only 1-2% can be salvaged 28,31,32 , although this has increased slightly with cyberknife and other techniques. In a large Danish national cohort study of 1523 patients with low-risk cervical cancer, of those with recurrent disease, 67.5% experienced a symptomatic recurrence 30 Other studies have shown similar rates of symptomatic recurrent cervical cancer 24 .…”