The acceptability of vaginal smear self-collection for screening for cervical cancer: a systematic review

Abstract

Cervical cancer is a major cause of death in adult women. However, many women do not undergo cervical cancer screening for the following reasons: fear, shame, physical limitations, cultural or religious considerations and lack of access to health care services. Self-collected vaginal smears maybe an alternative means of including more women in cervical cancer screening programs. The objective of this systematic review was to evaluate the acceptability of vaginal smear self-collection for cervical cancer screening. We selected articles from PubMed, the Cochrane Library and Embase that were published between January 1995 and April 2016. Studies written in English, French, Italian, Portuguese or Spanish that involved women between 18 and 69 years of age who had engaged in sexual intercourse were included in this review. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Nineteen studies were ultimately evaluated in this review. Most of the included studies (n=17) demonstrated that the self-collection method exhibited outstanding acceptability among women with respect to cervical cancer screening, and only two studies indicated that self-collection exhibited low acceptability among women in this context. The acceptability of self-collection was determined subjectively (without standardized questionnaires) in 10 studies (53%) and via structured and validated questionnaires in the remaining studies. The results of our review suggest that the self-collection method is well-accepted and may therefore encourage greater participation in cervical cancer screening programs. However, additional studies are required to verify these results.

“They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

“…These different options are also associated with different recommended intervals between screens (e.g., 3 years for a Pap test, 5–6 years for an HPV test), and different ages to start and stop screening. Recent systematic reviews suggest that most women find self-sampling preferable to clinician-collected sampling (Braz et al, 2017; Nelson et al, 2017; Racey, Withrow, & Gesink, 2013; Verdoodt et al, 2015) because of factors related to ease, ability to conduct the testing without a health care professional or by themselves, privacy, and lack of embarrassment.…”

Self‐collection of samples for HPV testing to increase participation in cervical cancer screening by immigrant women: An integrative review

“…Beyond the studies included in this review which focused on immigrant women, ample research has demonstrated that self-collection for HPV testing, regardless of device, is generally both feasible and acceptable for women across the globe (Arbyn et al, 2018;Braz et al, 2017;Nelson et al, 2017). The researchers whose papers were included in this review have begun to explore whether self-collection for HPV testing could help to overcome barriers to CCS for immigrant women who are persistently at risk for being under-screened in their countries of resettlement.…”

Strategies to Reach Marginalized Women for Cervical Cancer Screening: A Qualitative Study of Stakeholder Perspectives

“…The literature is similarly divided, such that some authors believe that self-sampling should be an option available to all eligible women (not just non-responders) 39,40 , while others suggest that self-sampling is appropriate only as a strategy to reach "non-compliant" women 24,41 , and yet others argue that self-sampling is not the best way to reach under-or never-screened groups 22,42 . Recent evidence syntheses suggest that most women find self-sampling preferable to clinician-collected sampling 23,43 . Other systematic reviews found that self-sampling could increase cervical screening coverage in under-or never-screened women 24 , though some authors observed similar uptake rates in opt-in scenarios 44 .…”