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Hansen BT, Nygård M, Castle PE, Burger EA, Aasbø G. Sociodemographic characteristics associated with cervical cancer screening participation by send-to-all and opt-in HPV self-sampling: Who benefits? Results from a randomized controlled trial among long-term non-attending women in Norway. Int J Cancer 2024; 155:1053-1067. [PMID: 38751040 DOI: 10.1002/ijc.34989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/11/2024] [Accepted: 04/12/2024] [Indexed: 07/16/2024]
Abstract
With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.
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Affiliation(s)
- Bo T Hansen
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Phil E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Emily A Burger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gunvor Aasbø
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Interdisciplinary Health Science, University of Oslo, Oslo, Norway
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Song J, Ni YH, Fang J, Qu SX, Chen XY, Wu WL, Zhang WC, Qin JF. The levels of women's awareness, experience, acceptability and preference for Vaginal Human Papillomavirus (HPV) self-sampling in three provinces of China: a cross-sectional study. BMC Womens Health 2024; 24:343. [PMID: 38877469 PMCID: PMC11179292 DOI: 10.1186/s12905-024-03186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The primary screening technique for precancerous lesions and cervical cancer is human papillomavirus (HPV) testing, and HPV self-sampling has been shown to be consistent with clinician sampling in terms of the accuracy of the results and may improve cervical cancer screening rates. The aim of this study was to understand the level of awareness, experience, acceptability, and preference for vaginal HPV self-sampling among women in Jiangsu, Zhejiang, and Shanghai, China, and to analyze the possible influencing factors to determine the feasibility of implementing self-sampling. METHODS Overall, 1793 women were included in the data analysis. A self-administered questionnaire was utilized. In addition to descriptive analysis, univariate and multivariate analyses were used to explore the associations between sociodemographic features, history of cervical cancer screening, and the level of awareness, experience, acceptability, and preference for HPV self-samples. RESULTS The participants' level of awareness of and experience with HPV self-sampling were moderate. A total of 88.8% of participants rated the acceptability as "high", and self-sampling was preferred by 64.2% of them for cervical cancer screening. People aged 45 to 54 years showed a preference for both clinician sampling(OR = 1.762 (1.116-2.163)) and self-sampling (OR = 1.823 (1.233-2.697)). Those who had graduated from high school or above (OR = 2.305 (1.517-3.503), OR = 2.432 (1.570-3.768), OR = 3.258 (2.024-5.244)) preferred clinician-sampling, and those with a bachelor's degree or above (OR = 1.664 (1.042-2.657)) preferred self-sampling. Middle- and high-income individuals showed no preference for either sampling method (OR < 1). CONCLUSIONS HPV self-sampling is widely accepted, but awareness, experience and preferences need to be improved. These results may help to adjust public health strategies for the early inclusion of HPV self-sampling as a screening method in national initiatives to prevent cervical cancer.
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Affiliation(s)
- Jia Song
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Yi-Hua Ni
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Jing Fang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Shui-Xiang Qu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Xiao-Yan Chen
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Wei-Li Wu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Wei-Chu Zhang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China
| | - Jian-Fen Qin
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, China.
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3
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Pataky RE, Izadi-Najafabadi S, Smith LW, Gottschlich A, Ionescu D, Proctor L, Ogilvie GS, Peacock S. Strategies to accelerate the elimination of cervical cancer in British Columbia, Canada: a modelling study. CMAJ 2024; 196:E716-E723. [PMID: 38830680 PMCID: PMC11142038 DOI: 10.1503/cmaj.231682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND To eliminate cervical cancer in Canada by 2040, defined as an annual age-standardized incidence rate (ASIR) lower than 4.0 per 100 000 women, the Canadian Partnership Against Cancer (CPAC) identified 3 priorities for action: increasing human papillomavirus (HPV) vaccine coverage, implementing HPV-based screening and increasing screening participation, and improving follow-up after abnormal screen results. Our objective was to explore the impact of these priorities on the projected time to elimination of cervical cancer in British Columbia. METHODS We used OncoSim-Cervical, a microsimulation model led and supported by CPAC and developed by Statistics Canada that simulates HPV transmission and the natural history of cervical cancer for the Canadian population. We updated model parameters to reflect BC's historical participation rates and program design. We simulated the transition to HPV-based screening and developed scenarios to explore the additional impact of achieving 90% vaccination coverage, 95% screening recruitment, 90% ontime screening, and 95% follow-up compliance. We projected cervical cancer incidence, ASIR, and year of elimination for the population of BC for 2023-2050. RESULTS HPV-based screening at current vaccination, participation, and follow-up rates can eliminate cervical cancer by 2034. Increasing on-time screening and follow-up compliance could achieve this target by 2031. Increasing vaccination coverage has a small impact over this time horizon. INTERPRETATION With the implementation of HPV-based screening, cervical cancer can be eliminated in BC before 2040. Efforts to increase screening participation and follow-up through this transition could potentially accelerate this timeline, but the transition from cytology- to HPV-based screening is fundamental to achieving this goal.
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Affiliation(s)
- Reka E Pataky
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
| | - Sara Izadi-Najafabadi
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
| | - Laurie W Smith
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
| | - Anna Gottschlich
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
| | - Diana Ionescu
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
| | - Lily Proctor
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
| | - Gina S Ogilvie
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
| | - Stuart Peacock
- Cancer Control Research (Pataky, Izadi-Najafabadi, Smith, Peacock), BC Cancer; Canadian Centre for Applied Research in Cancer Control (Pataky, Izadi-Najafabadi); Women's Health Research Institute (Smith, Ogilvie), BC Women's Hospital and Health Centre, Vancouver, BC; Karmanos Cancer Institute (Gottschlich), Wayne State University, Detroit Mich.; Faculty of Medicine (Ionescu, Proctor), University of British Columbia; Cervix Screening Program (Ionescu, Proctor), BC Cancer; School of Population and Public Health (Ogilvie), University of British Columbia; Faculty of Health Sciences (Peacock), Simon Fraser University, Vancouver, BC
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Descamps P, Dixon S, Bosch Jose FX, Kyrgiou M, Monsonego J, Neisingh O, Nguyen L, O'Connor M, Smith JS. Turning the tide-Recommendations to increase cervical cancer screening among women who are underscreened. Int J Gynaecol Obstet 2024; 166 Suppl 1:3-21. [PMID: 38853590 DOI: 10.1002/ijgo.15600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Philippe Descamps
- Co-Chair, ACCESS Consensus Group, Professor and Chairman, Department of Obstetrics and Gynecology, University Hospital Angers, Former Vice President of FIGO, and President of International Relations Committee, CNGOF (French College of Obstetricians and Gynecologists), Angers, France
| | - Samantha Dixon
- Former Co-Chair, ACCESS Consensus Group, Former CEO, Jo's Cervical Cancer Trust, London, UK
| | - Francesc Xavier Bosch Jose
- Clinical Oncologist, Epidemiologist, Co-founder, HPV Information Center (ICO and IARC), Director, HPV World (HPW), Barcelona, Spain
| | - Maria Kyrgiou
- Consultant Surgeon in Gynecology and Gynecological Oncology, Imperial College London, London, UK
| | - Joseph Monsonego
- Gynecologist-Oncologist, Founding President of EUROGIN, President of 1000 Femmes 1000 Vies Patient Association, Paris, France
| | - Ody Neisingh
- Independent Consultant and Public Affairs Advisor, with Extensive Working Experience at WOMEN Inc. and UN Women, and Member of the European Economic and Social Committee on behalf of Gender Equality Civil Society, Amsterdam, The Netherlands
| | - Lananh Nguyen
- Director of Cytopathology and Assistant Professor, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Mairead O'Connor
- Research Officer, National Screening Service Ireland, Dublin, Ireland
| | - Jennifer S Smith
- Professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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5
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Rebolj M, Brentnall AR, Cuschieri K. Predictable changes in the accuracy of human papillomavirus tests after vaccination: review with implications for performance monitoring in cervical screening. Br J Cancer 2024; 130:1733-1743. [PMID: 38615108 PMCID: PMC11130303 DOI: 10.1038/s41416-024-02681-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024] Open
Abstract
Vaccination against human papillomavirus (HPV) is changing the performance of cytology as a cervical screening test, but its effect on HPV testing is unclear. We review the effect of HPV16/18 vaccination on the epidemiology and the detection of HPV infections and high-grade cervical lesions (CIN2+) to evaluate the likely direction of changes in HPV test accuracy. The reduction in HPV16/18 infections and cross-protection against certain non-16/18 high-risk genotypes, most notably 31, 33, and/or 45, will likely increase the test's specificity but decrease its positive predictive value (PPV) for CIN2+. Post-vaccination viral unmasking of non-16/18 genotypes due to fewer HPV16 co-infections might reduce the specificity and the PPV for CIN2+. Post-vaccination clinical unmasking exposing a higher frequency of CIN2+ related to non-16/18 high-risk genotypes is likely to increase the specificity and the PPV of HPV tests. The effect of HPV16/18 vaccination on HPV test sensitivity is difficult to predict based on these changes alone. Programmes relying on HPV detection for primary screening should monitor the frequency of false-positive and false-negative tests in vaccinated (younger) vs. unvaccinated (older) cohorts, to assess the outcomes and performance of their service.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Screening, Prevention, and Early Detection, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Adam R Brentnall
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK
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6
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Heideman DAM, Berkhof J, Verhoef L, Ouwerkerk C, Smit PW, Oštrbenk Valenčak A, Mlakar J, Poljak M, Steenbergen RDM, Bleeker MCG. Validation of the clinical performance and reproducibility of the NeuMoDx HPV assay self-sample workflow. J Clin Virol 2024; 171:105649. [PMID: 38335717 DOI: 10.1016/j.jcv.2024.105649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) testing on self-samples is a valid tool for cervical cancer screening. HPV self-sample workflows need to be clinically validated to ensure safe use in screening. OBJECTIVE This study evaluated the fully automated NeuMoDx HPV Assay self-sample workflow that is compiled of the NeuMoDx HPV assay and the NeuMoDx 96/288 Molecular Systems, for clinical performance and reproducibility on Evalyn Brush-collected self-samples. METHODS The clinical performance of the NeuMoDx HPV Assay self-sample workflow for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3+ was evaluated on 987 self-samples obtained from women attending national organized HPV-based cervical cancer screening by a noninferiority analysis relative to reference workflows using either HPV-Risk Assay or high-risk HPV GP5+/6+-PCR. Intra- and inter-laboratory reproducibility of the NeuMoDx HPV Assay self-sample workflow using both NeuMoDx 96 and 288 Molecular Systems was assessed on 520 self-samples in three laboratories. RESULTS The clinical sensitivity and specificity of the NeuMoDx HPV Assay self-sample workflow for the detection of CIN2+ and CIN3+ were found to be non-inferior to the reference workflows using either HPV-Risk Assay or high-risk HPV GP5+/6+-PCR, with all p-values <0.034. The NeuMoDx HPV Assay self-sample workflow exhibited an intra-laboratory reproducibility of 94.4 % (95 %CI:92.5-96.1 %) with kappa value 0.86 (95 %CI:0.81-0.91). Inter-laboratory agreement was high (all ≥93.4 % and all kappa values ≥0.83). CONCLUSIONS The NeuMoDx HPV Assay self-sample workflow demonstrated high clinical accuracy for CIN2+/3+ and high reproducibility. The NeuMoDx HPV Assay self-sample workflow can be considered suitable for cervical cancer screening purposes.
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Affiliation(s)
- D A M Heideman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands.
| | - J Berkhof
- Amsterdam UMC location Vrije Universiteit Amsterdam, Data Sciences, De Boelelaan 1117, Amsterdam, Netherlands
| | - L Verhoef
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - C Ouwerkerk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - P W Smit
- Molecular Diagnostics Unit, Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, Netherlands
| | - A Oštrbenk Valenčak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - J Mlakar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - R D M Steenbergen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
| | - M C G Bleeker
- Amsterdam UMC location Vrije Universiteit Amsterdam, Pathology, De Boelelaan 1117, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands
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7
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Sechi I, Muresu N, Puci MV, Saderi L, Del Rio A, Cossu A, Muroni MR, Castriciano S, Martinelli M, Cocuzza CE, Sotgiu G, Piana A. Preliminary Results of Feasibility and Acceptability of Self-Collection for Cervical Screening in Italian Women. Pathogens 2023; 12:1169. [PMID: 37764977 PMCID: PMC10535381 DOI: 10.3390/pathogens12091169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Given the diagnostic accuracy of HPV-DNA tests in terms of self-collected samples, in order to implement self-sampling in cervical screening programs, the standardization of the pre-analytical phase, including decisions concerning the choice of medium, the volume of elution, and storage conditions, are necessary, in addition to understanding the potential factors involved in acceptability by women. On this basis, we carried out a cross-sectional study to assess (i) the stability of dry vaginal self-collected samples stored at room temperature for up to 4 weeks after elution in 2 mL of eNat® (Copan) medium, and (ii) the acceptability of self-collection in enrolled women. METHODS 185 women were enrolled in the LILT (Italian League Against Tumors) regional project. A self-sampling kit, including a dry FLOQSwab® (Copan), instructions for use, and a satisfaction questionnaire, were supplied for each woman and sent by mail to the laboratory. The HPV-DNA test was carried out using the Anyplex™ II HPV HR (Seegene) kit. To evaluate the specimen's stability, 185 dry vaginal swabs were eluted in eNat®, a lyses-based molecular medium and tested for HPV detection at two different time points (<6 days and 1 month after elution). The Cohen's Kappa coefficients and McNemar test were used to assess the agreement of HPV-DNA at different times. RESULTS We found high agreement in terms of HPV-DNA results among the samples tested at two different time points (Cohen K = 0.98; p < 0.0001). Moreover, most of the women found it easy to use self-collection devices and the pictorial instructions clear to understand. Approximately half of the enrolled women declared preferring self-sampling to clinician-collected methods. CONCLUSION Our results display the high reliability and accuracy of HPV-DNA tests using dry vaginal self-collection FLOQSwabs® devices eluted in 2 mL of molecular medium. The analysis of the questionnaire showed a high acceptability of self-collection among women, although a high percentage preferred standard collection devices. Overall, our preliminary results support the adoption of self-collection in screening programs, even though further analyses should be performed to optimize and standardize protocols for HPV tests on self-samples, and educational campaigns are needed to adequately inform and increase responsiveness in a target population.
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Affiliation(s)
- Illari Sechi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
| | - Narcisa Muresu
- Department of Humanities and Social Sciences, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy
| | - Mariangela V. Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Pharmacological Sciences, University of Sassari-Padre Manzella 4 Street, 07100 Sassari, Italy; (M.V.P.); (L.S.); (G.S.)
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Pharmacological Sciences, University of Sassari-Padre Manzella 4 Street, 07100 Sassari, Italy; (M.V.P.); (L.S.); (G.S.)
| | - Arcadia Del Rio
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy;
| | - Andrea Cossu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
| | - Maria R. Muroni
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
| | | | - Marianna Martinelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore 48 street, 20900 Monza, Italy; (M.M.); (C.E.C.)
| | - Clementina E. Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, Cadore 48 street, 20900 Monza, Italy; (M.M.); (C.E.C.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Pharmacological Sciences, University of Sassari-Padre Manzella 4 Street, 07100 Sassari, Italy; (M.V.P.); (L.S.); (G.S.)
| | - Andrea Piana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Padre Manzella 4 Street, 07100 Sassari, Italy; (I.S.); (A.C.); (M.R.M.); (A.P.)
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8
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Daponte N, Valasoulis G, Michail G, Magaliou I, Daponte AI, Garas A, Grivea I, Bogdanos DP, Daponte A. HPV-Based Self-Sampling in Cervical Cancer Screening: An Updated Review of the Current Evidence in the Literature. Cancers (Basel) 2023; 15:cancers15061669. [PMID: 36980555 PMCID: PMC10046242 DOI: 10.3390/cancers15061669] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Identifying and reaching women at higher risk for cervical cancer is all-important for achieving the ambitious endpoints set in 2020 by the WHO for global cervical cancer control by 2030. HPV-based (vaginal) self-sampling (SS) represents a cost-effective screening strategy, which has been successfully implemented during the last decade both in affluent and constrained settings. Among other advantages, SS strategies offer convenience, diminished costs, flexibility to obtain a sample in the office or home, avoiding a pelvic exam and uncomfortable appointment with a healthcare professional, as well as social and cultural acceptability. SS implementation has been globally boosted during the COVID-19 pandemic. In pragmatic terms, social distancing, local lockdowns, discontinuation of clinics and reallocation of human and financial resources challenged established clinician-based screening; self-collection strategies apparently surpassed most obstacles, representing a viable and flexible alternative. With time, sufficient reassuring data has accumulated regarding specially designed SS devices, aspects of sample preparation, transport and storage and, importantly, optimization of validated PCR-based HPV testing platforms for self-collected specimens. Suboptimal rates of clinical follow-up post-SS screening, as well as overtreatment with reliance solely on molecular assays, have both been documented and remain concerning. Therefore, effective strategies are still required to ensure linkage to follow-up testing and management following positive SS results by trained health professionals with knowledge of HPV biology and management algorithms. Because of the prolonged SS screening intervals, implementation data are limited regarding subsequent screening rounds of SS-screened individuals; however, these are accumulating gradually. With further refinement of assays and validation of novel biomarkers in self-collected samples, there is a clear potential for increasing SS accuracy and PPV. The potential differentiation of self-collection protocols for vaccinated versus non-vaccinated individuals also represents an open issue. In conclusion, HPV-based self-collection techniques can effectively address limited uptake alongside other conventional cervical screening drawbacks; however, assays, logistics and infrastructures need further optimization to increase the efficacy, effectiveness and cost-effectiveness of SS approaches.
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Affiliation(s)
- Nikoletta Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - George Valasoulis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
- Hellenic National Public Health Organization-ECDC, Marousi, 15123 Athens, Greece
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, 50100 Kozani, Greece
| | - Georgios Michail
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Ioulia Magaliou
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, 50100 Kozani, Greece
| | - Athina-Ioanna Daponte
- Second Department of Dermatology-Venereology, Aristotle University School of Medicine, 54124 Thessaloniki, Greece
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Ioanna Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larisa, Greece
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Costa S, Verberckmoes B, Castle PE, Arbyn M. Offering HPV self-sampling kits: an updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening. Br J Cancer 2023; 128:805-813. [PMID: 36517552 PMCID: PMC9977737 DOI: 10.1038/s41416-022-02094-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) testing on self-samples represents a great opportunity to increase cervical cancer screening uptake among under-screened women. METHODS A systematic review and meta-analysis on randomised controlled trials (RCTs) were performed to update the evidence on the efficacy of strategies for offering self-sampling kits for HPV testing compared to conventional invitations and to compare different self-sampling invitation scenarios. Four experimental invitational scenarios were considered. Women in the control group were invited for screening according to existing practice: collection of a cervical specimen by a healthcare professional. Random-effects models were used to pool proportions, relative participation rates and absolute participation differences. RESULTS Thirty-three trials were included. In the intention-to-treat analysis, all self-sampling invitation scenarios were more effective in reaching under-screened women compared to controls. Pooled participation difference (PD) and 95% confidence interval (CI) for experimental vs. control was 13.2% (95% CI = 11.0-15.3%) for mail-to-all, 4.4% (95% CI = 1.2-7.6%) for opt-in, 39.1% (95% CI = 8.4-69.9%) for community mobilisation & outreach and 28.1% (23.5-32.7%) for offer at healthcare service. PD for the comparison opt-in vs. mail-to-all, assessed in nine trials, was -8.2% (95% CI = -10.8 to -5.7%). DISCUSSION Overall, screening participation was higher among women invited for self-sampling compared to control, regardless of the invitation strategy used. Opt-in strategies were less effective than send-to-all strategies.
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Affiliation(s)
- Stefanie Costa
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Bo Verberckmoes
- International Centre for Reproductive Health, Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Arbyn M, Costa S, Latsuzbaia A, Kellen E, Girogi Rossi P, Cocuzza CE, Basu P, Castle PE. HPV-based Cervical Cancer Screening on Self-samples in the Netherlands: Challenges to Reach Women and Test Performance Questions. Cancer Epidemiol Biomarkers Prev 2023; 32:159-163. [PMID: 36744312 DOI: 10.1158/1055-9965.epi-22-1041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 02/07/2023] Open
Abstract
In 2017, cervical cancer screening in the Netherlands switched from cytology to human papillomavirus (HPV) testing using the validated PCR-based cobas 4800. Women could order and subsequently received a free self-sampling kit (Evalyn Brush) at their home address instead of clinician sampling. In the laboratory, the shipped brush was placed into 20 mL of PreservCyt fluid, before testing. In the first 2 years of the new program, only 7% of screening tests were performed on a self-sample. Those who chose self-sampling versus clinician sampling were more likely to have never been screened previously and differed also with respect to sociodemographic factors. Subsequent more active promotion and increasing the ease to obtain kits increased the proportion opting for self-sampling (16% in 2020). HPV positivity and detection rate of precancer (CIN3+) were lower in the self-sampling compared with the clinician-sampling group (adjusted ORs of 0.65 and 0.86, respectively). Although population differences may partially explain these results, self-samples may have been too dilute, thereby reducing the analytic and clinical sensitivity. The Dutch findings demonstrate the importance of optimizing outreach, specimen handling and testing protocols for self-samples to effectively screen the target population and reach in particular the women at highest risk for cervical cancer. See related article by Aitken et al., p. 183.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stefanie Costa
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Ardashel Latsuzbaia
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | | | - Paolo Girogi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Partha Basu
- International Agency for Research in Cancer, Lyon, France
| | - Philip E Castle
- Divisions of Cancer Prevention and Cancer Epidemiology and Genetics, NCI, Rockville, Maryland
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