A study published January 23 in the Journal of the National Cancer Institute , has found that self-HPV (human papillomavirus) testing, in low-resource settings, may be a more effective way to screen for cervical cancer than liquid-based cytology (LBC) and visual inspection with acetic acid (VIA).
Cervical cancer is one of the most prevalent cancers found in women. Each year, around 530,000 women are diagnosed with the disease, resulting in an estimated 275,000 deaths.
Cervical cytology screening campaigns, which require considerable laboratory infrastructure and medical resources, have helped lower the number of cervical cancer cases in developed countries. However, in developing countries cervical cancer is increasing, with one-seventh of the world’s cases in China.
As there is currently no nationwide screening program for cervical cancer in China, researchers have suggested that self-HPV testing may serve as an additional or alternative method of primary cervical cancer screening method.
Data from individual participants from 5 population-based cervical cancer-screening studies in China from 1997 to 2007 was collected by Professor You-Lin Qiao, M.D., Ph.D., of the Cancer institute/Hospital at the Chinese Academy of Medical Sciences/Peking Union Medical college and colleagues, in order to find out the effectiveness of self-HPV testing. Participants’ in the five studies received HPV testing of physician-collected Pap specimens, LBC, and VIA, HPV testing of self-collected Pap specimens (self-HPV testing).
The pooled data was then examined in order to identify biopsy-confirmed cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) or CIN3+.
The researchers found:
- 507 of the 13,140 rural Chinese women screened for the disease were diagnosed with CIN2+
- 273 were diagnosed with CIN3+
- and 37 were diagnosed with cervical cancer
Results from the study showed that self-HPV testing was less specific and more sensitive than VIA and LBC. Although, compared to physician-collected Pap specimens, self-HPV testing was similarly specific, but less sensitive.
According to the researchers, self-HPV testing may help China expand it’s current screening outreach.
The researchers explain:
“Although it is not specific enough to be a stand-alone test, self-HPV testing provides sensitive results without pelvic exams, medical professionals, or health-care facilities and thus has the potential to serve as a primary cervical cancer screening method for women, regardless of their geographic location or access to health care.
Self-sampling procedures were instructed by medical professionals, and it is unclear whether unsupervised self-examinations would give out similar outcomes.
The incorporation of Self-HPV testing in the Chinese government’s planning of a national cervical cancer screening program would complement the current program by increasing its coverage of unscreened populations.”
In an associated report, Patrick Petignat, M.D., of the University Hospitals of Geneva, explains that although self-HPV testing for primary cervical cancer screening may help increase the number of women being screened, introducing self-HPV testing should be met with caution.
According to Petignat, determining women’s personal willingness to undergo self-screening, as well as the cost effectiveness of self-HPV testing is vital. In addition, he believes patients need to be fully educated about self-HPV testing.
“Efforts are still needed to increase awareness about HPV and cervical cancer and more information is needed about the reliability of the method. Health-care professionals should provide sufficient support to participants to properly interpret their test results, thus avoiding any delay to follow-up and treatment.”
Written by Grace Rattue