Self-sampling to improve cervical cancer screening coverage in Switzerland: a randomised controlled trial

Viviano, Manuela; Catarino, Rosa; Jeannot, Émilien; Boulvain, Michel; Malinverno, Manuela Undurraga; Vassilakos, Pierre; Petignat, Patrick

doi:10.1038/bjc.2017.111

Cited by 21 publications

(21 citation statements)

References 28 publications

(34 reference statements)

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“…While in a Norwegian trial, 94.1% of women tested positive attended follow up . In a Swiss study, there were 5.05% (95% CI: 3.1–8.1) women with a positive screen who did not attend triage and colposcopy . In an Australian study 75.7% of the hrHPV positive women had appropriate clinical follow‐up .…”

Section: Discussionmentioning

confidence: 94%

“…19 In a Swiss study, there were 5.05% (95% CI: 3.1-8.1) women with a positive screen who did not attend triage and colposcopy. 20 In an Australian study 75.7% of the hrHPV positive women had appropriate clinical follow-up. 21 In a French study targeting a low-income population, only 41% of the women who tested positive for hrHPV had a follow up PAP smear taken.…”

Section: Discussionmentioning

confidence: 99%

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A randomized, controlled trial of two strategies of offering the home‐based HPV self‐sampling test to non‐ participants in the Flemish cervical cancer screening program

Kellen

Benoy

Broeck

et al. 2018

Intl Journal of Cancer

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We conducted a randomized, controlled trial to evaluate different strategies of offering an HPV-self sampling program, and compared this with two control groups. All total of 35,354 women who did not participate in the Flemish cancer screening program were included in the study: 9,118 received a HPV self-collection brush (RIATOL qPCR HPV genotyping test (qPCR [E6/E7]); 9,098 were offered the opportunity to order an HPV-selfsampling brush, 8,830 received the recall letter; 8,849 received no intervention. Within 12 months after the mailing, 18.7% of the women who had received the brush, participated by returning a self-sample sample, while 10.6% women allocated to the opt- in group did so. 10.5% women who received the standard recall letter, had a PAP smear taken within a period of 12 months; while 8% women did so without receiving an intervention at all. Participation in postmenopausal women was higher than in women younger than 50 in both self-sampling arms. Screening by means of the self-sample kit increased by age, contradictory when screening is performed by a PAP smear. Of those testing hrHPV positive (9.5%), 88.9% attended for follow up cytology. The mean DNA concentration, found in the self-sampler, decreased by age, causing a higher number of inconclusive results. Our results support the efficacy of a self-sampling strategy to increase participation in the Flemish screening program. Self-sampling seems particularly acceptable to postmenopausal non-responders. Future research should focus on the performance of different self-sampling devices in post-menopausal women as low DNA concentrations exponentially increased over age.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

A randomized, controlled trial of two strategies of offering the home‐based HPV self‐sampling test to non‐ participants in the Flemish cervical cancer screening program

Kellen

Benoy

Broeck

et al. 2018

Intl Journal of Cancer

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“…After two independent reviewers screened in duplicate and gained consensus, 149 articles were pulled for full-text review. Of these, 33 studies (reported in 34 articles) were included in the review 21–54…”

Section: Resultsmentioning

confidence: 99%

Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis

Yeh

Kennedy

Vuyst³

et al. 2019

BMJ Glob Health

196

197

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IntroductionHuman papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic review and meta-analysis of HPV self-sampling among adult women on cervical (pre-)cancer screening uptake, screening frequency, social harms/adverse events and linkage to clinical assessment/treatment.MethodsThe included studies compared women using cervical cancer screening services with HPV self-sampling with women using standard of care, measured at least one outcome, and were published in a peer-reviewed journal. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CNIAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and Embase through October 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR).Results33 studies in 34 articles with 369 017 total participants met the inclusion criteria: 29 RCTs and 4 observational studies. All studies examined HPV self-sampling; comparison groups were standard of care (eg, Pap smear, visual inspection with acetic acid, clinician-collected HPV testing). 93% of participants were from high-income countries. All 33 studies measured cervical cancer screening uptake. Meta-analysis found greater screening uptake among HPV self-sampling participants compared with control (RR: 2.13, 95% CI 1.89 to 2.40). Effect size varied by HPV test kit dissemination method, whether mailed directly to home (RR: 2.27, 95% CI 1.89 to 2.71), offered door-to-door (RR: 2.37, 95% CI 1.12 to 5.03) or requested on demand (RR: 1.28, 95% CI 0.90 to 1.82). Meta-analysis showed no statistically significant difference in linkage to clinical assessment/treatment between arms (RR: 1.12, 95% CI 0.80 to 1.57). No studies measured screening frequency or social harms/adverse events.ConclusionA growing evidence base, mainly from high-income countries and with significant heterogeneity, suggests HPV self-sampling can increase cervical cancer screening uptake compared with standard of care, with a marginal effect on linkage to clinical assessment/treatment.Systematic review registration numberPROSPERO CRD42018114871.

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“…Human papillomavirus (HPV) testing in self-collected cervicovaginal samples (HPV self-sampling for short) has been increasingly investigated as a potential screening alternative to standard physician-based sampling to complement primary cervical cancer screening programs by enhancing coverage among nonattendees. It has been implemented in the Netherlands (1) and Australia (2), and other countries, including the United States (3), United Kingdom (4), Norway (5), Denmark (6), and Switzerland (7), are evaluating its incorporation into national cervical screening programs (8). The utility of HPV self-sampling in cervical cancer screening is predicated on the availability of validated HPV assays (9).…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of HPV Testing in Self-collected and Clinician-Collected Samples Compared with Cytology in Detecting High-grade Cervical Lesions

El‐Zein

Bouten

Louvanto

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Self-sampling has become an attractive proposition now that human papillomavirus (HPV) primary testing is being incorporated into cervical cancer screening programs worldwide. We compared predictive values of HPV testing based on self-and physician-collected samples, and cytology, in detecting high-grade cervical intraepithelial neoplasia (CIN).Methods: The Cervical And Self-Sample In Screening (CASSIS) study enrolled 1,217 women ages 16-70 years prior to scheduled colposcopies. Vaginal specimens were self-collected using the validated HerSwab device. Cervical specimens were collected by gynecologists. Specimens were tested for presence of high-risk HPV (hrHPV) by the Cobas 4800 HPV test. We estimated positive predictive values (PPV) and negative predictive values (NPV) and 95% confidence intervals (CI) for a subset of women (n ¼ 700) who underwent cervical biopsy and cytology at the actual CASSIS visit.Results: hrHPV was detected in 329 women (47%) with HerSwab and in 327 (46.7%) with physician sampling. Respective values for HPV16/18 were 119 (17%) and 121 (17.3%). On histology, 134 women had CIN1, 49 had CIN2, 48 had CIN3, 5 had CIN2/CIN3, and 3 had cancers. PPVs for CIN2 þ of any hrHPV were 28% (95% CI, 23.2-33.1) and 29.7% (95% CI, 24.8-34.9) for HerSwab and physician samples, respectively. Corresponding values for HPV16/18 were 43.7% (95% CI, 34.6-53.1) and 43.8% (95% CI, 34.8-53.1). PPV of cytology (ASC-USþ) was 26.6% (95% CI, 21.6-32.0). Corresponding NPVs (same order as PPVs) were 96.4% (95% CI, 93.9-98.1), 97.8% (95% CI, 95.6-99), 90.9% (95% CI, 88.2-93.1), 91% (95% CI, 88.4-93.2), and 94.7% (95% CI, 91.8-96.8).Conclusions: Our results confirm that HPV self-sampling has comparable performance with a physician-collected sample in detecting cervical lesions.Impact: HPV self-sampling has the potential to increase coverage in cervical cancer screening.

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Self-sampling to improve cervical cancer screening coverage in Switzerland: a randomised controlled trial

Cited by 21 publications

References 28 publications

A randomized, controlled trial of two strategies of offering the home‐based HPV self‐sampling test to non‐ participants in the Flemish cervical cancer screening program

A randomized, controlled trial of two strategies of offering the home‐based HPV self‐sampling test to non‐ participants in the Flemish cervical cancer screening program

Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis

Predictive Value of HPV Testing in Self-collected and Clinician-Collected Samples Compared with Cytology in Detecting High-grade Cervical Lesions

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