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Huntington S, Smith JS, Nuttall D, Polokaova A, Smith PM, Hamlyn-Williams C, Adams E. Evidence from Europe on implementation, participation and performance of self-collection for cervical cancer screening. Future Oncol 2024:1-12. [PMID: 39445605 DOI: 10.1080/14796694.2024.2409625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 09/24/2024] [Indexed: 10/25/2024] Open
Abstract
Cervical cancer screening programs reduce the number of cervical cancer cases and deaths, but the success of any screening program is dependent on high participant uptake and coverage and many European countries are observing declining cervical cancer screening coverage to below national targets. Self-collection of vaginal samples for human papillomavirus testing, also termed self-sampling, is one strategy which is being introduced to try to increase screening coverage by removing barriers to participation and it has attracted growing interest and support globally. Informed by peer-reviewed and gray literature, this narrative review starts with a case study from the Netherlands and outlines the self-collection landscape in Europe within the themes of program implementation and relative test performance. It highlights some of the current evidence gaps needed to inform policy decisions on the use of self-collection within screening programs.
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Affiliation(s)
| | - Jennifer S Smith
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, 27599
| | - Dave Nuttall
- Discipline of Histopathology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- CERVIVA - the Irish Cervical Screening Consortium, Dublin, Ireland
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Lim AW, Deats K, Gambell J, Lawrence A, Lei J, Lyons M, North B, Parmar D, Patel H, Waller J, Warwick J, Sasieni PD. Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen). EClinicalMedicine 2024; 73:102672. [PMID: 39429813 PMCID: PMC11490653 DOI: 10.1016/j.eclinm.2024.102672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 10/22/2024] Open
Abstract
Background Self-sampling has game-changing potential to tackle the declining participation and inequities seen in many organised cervical screening programmes. Wide variation in uptake between settings and mode of kit offer highlight the importance of local piloting. Furthermore, harnessing the benefits of self-sampling in real-world settings has been surprisingly challenging. The YouScreen study estimated the impact of offering self-sampling to non-attenders within the English Programme and evaluated large-scale opportunistic offering of self-sampling in primary care. Methods A pragmatic modified stepped-wedge implementation feasibility trial with randomly-allocated cluster intervention start dates at primary care practices in England (133 participating, 62 non-participating). Eligible women were aged 25-64 years and ≥6 months overdue for screening ("non-attenders"). Between January 13, 2021 and 30 November, 2021 self-sampling kits were distributed to non-attenders via an opportunistic offer in primary care when they consulted for any reason and direct mailout to those unscreened 15-months after routine invitation. Primary outcomes were the proportion of non-attenders screened each month; change in coverage; and uptake (90 days). YouScreen is registered with ISRCTN:12759467. Findings 8338 women provided self-samples following recruitment between January 13, 2021 and 30 November, 2021. Self-samples were returned from 65.5% (6061/9248) who accepted an opportunistically offered kit and 12.9% (2777/17,604) directly-mailed kits. Responders were representative of the ethnically diverse and deprived underlying non-attendee population (64% ethnic minority groups, 60% from the two most deprived national quintiles). The self-sampling intervention resulted in a 22% (95% CI 18-26) increase in non-attenders screened per month (per-protocol analysis) and 12% (95% CI 9-15) (intention-to-treat analysis). Change in coverage at participating (mean intervention duration 7.5 months) vs non-participating practices was 1.6% (95% CI 0.4-2.8). Adverse effects were not formally collected. Interpretation Opportunistically offering self-sampling to under-screened women in primary care could increase coverage in England and potentially reach underserved populations. Funding North Central London and North East London Cancer Alliance.
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Affiliation(s)
- Anita W.W. Lim
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK
| | - Katie Deats
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Joanna Gambell
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Alexandra Lawrence
- Barts Health NHS Trust, Department of Gynaecology, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
| | - Jiayao Lei
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Mairead Lyons
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 9RT, UK
| | - Bernard North
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Dharmishta Parmar
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Hasit Patel
- Health Service Laboratories LLP, Level 8 #, The Halo Building, Mabledon Place, London, WC1H 9AX, UK
| | - Jo Waller
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Jane Warwick
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Peter D. Sasieni
- Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, EC1M 6BQ, UK
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Creagh NS, Saunders T, Brotherton J, Hocking J, Karahalios A, Saville M, Smith M, Nightingale C. Practitioners support and intention to adopt universal access to self-collection in Australia's National Cervical Screening Program. Cancer Med 2024; 13:e7254. [PMID: 38785177 PMCID: PMC11117194 DOI: 10.1002/cam4.7254] [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: 09/08/2023] [Revised: 03/12/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Primary care practitioners are crucial to engaging people in Australia's national cervical screening program. From July 2022, practitioners have been able to offer all screen-eligible people the choice to collect their own self-collected sample; an option introduced to increase equity. This study explored how practitioners are intending to incorporate universal access to self-collection into their clinical care. METHODS Semi-structed interviews with 27 general practitioners, nurses, and practice managers from 10 practices in Victoria, Australia conducted between May and August 2022. Interviews were deductively coded, informed by the Consolidated Framework for Implementation Research. The Diffusion of Innovations theory was used to categorise intention to provide self-collection. RESULTS Participants were supportive of universal access to self-collection, citing benefits for screen-eligible people and that it overcame the limited adaptability of the previous policy. Most participants' practices (n = 7, 70%) had implemented or had plans to offer the option for self-collection to all. Participants deliberating whether to provide universal access to self-collection held concerns about the correct performance of the self-test and the perceived loss of opportunity to perform a pelvic examination. Limited time to change practice-level processes and competing demands within consultations were anticipated as implementation barriers. CONCLUSIONS The extent to which self-collection can promote equity within the program will be limited without wide-spread adoption by practitioners. Communication and education that addresses concerns of practitioners, along with targeted implementation support, will be critical to ensuring that self-collection can increase participation and Australia's progression towards elimination of cervical cancer.
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Affiliation(s)
- Nicola Stephanie Creagh
- Centre for Health Policy, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Tessa Saunders
- Centre for Health Policy, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Julia Brotherton
- Centre for Health Policy, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical CancerCarltonVictoriaAustralia
| | - Megan Smith
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Claire Nightingale
- Centre for Health Policy, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
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Whittaker M, Davies JC, Sargent A, Sawyer M, Crosbie EJ. A comparison of the carbon footprint of alternative sampling approaches for cervical screening in the UK: A descriptive study. BJOG 2024; 131:699-708. [PMID: 38012840 DOI: 10.1111/1471-0528.17722] [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: 06/29/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To understand whether self-sampling can reduce carbon emissions (CO2 e) from the NHS cervical screening programme (NHSCSP) by comparing the carbon footprint of three sampling strategies: routine cervical sampling, vaginal self-sampling and first-void (FV) urine collection. DESIGN Descriptive study. SETTING National Health Service (NHS), United Kingdom (UK). POPULATION OR SAMPLE Patients aged 25-64 years eligible for cervical screening in the UK. METHODS A carbon footprint analysis was undertaken for three cervical screening sampling approaches, from point of invitation to screening through to preparation for transport to the laboratory for HPV testing. A combination of primary and secondary data were used, with a bottom-up approach applied to collection of primary data. MAIN OUTCOME MEASURES We report CO2 e per sampling approach, which is the unit used to express carbon footprint and harmonise the contributions of greenhouse gases with different global warming potentials. RESULTS The total carbon footprint of routine cervical sampling is 3670 g CO2 e. By comparison, vaginal self-sampling had a total carbon footprint of 423 g CO2 e, and FV urine sampling 570 g CO2 e. The largest share of emissions for routine sampling was attributable to the carbon footprint associated with an appointment in a primary care setting, which totalled 2768 g CO2 e. CONCLUSIONS Routine cervical sampling is up to 8.7-fold more carbon-intensive than self-sampling approaches with equivalent effectiveness. We found negligible differences in the carbon footprint of alternative self-sampling methods, supporting the need for an informed choice of screening options for participants, which includes sharing information on their environmental impacts.
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Affiliation(s)
- Maya Whittaker
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jennifer C Davies
- Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alexandra Sargent
- Manchester University NHS Foundation Trust, Manchester, UK
- Cytology Department, Clinical Sciences Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Matt Sawyer
- SEE Sustainability, Leeming Bar, Northallerton, North Yorkshire, UK
| | - Emma J Crosbie
- Manchester University NHS Foundation Trust, Manchester, UK
- Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Fitch K, Bohn JA, Emerson JB, Boniface ER, Bruegl A. Acceptability of human papillomavirus self-collection and the role of telehealth: a prospective, randomized study stratified by menopausal status. Int J Gynecol Cancer 2024; 34:19-27. [PMID: 38101813 DOI: 10.1136/ijgc-2023-004935] [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] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE We investigated the utility of telehealth instruction versus mail-based written instruction in facilitating high-risk human papillomavirus (hrHPV) self-collection among post-menopausal patients compared with pre-menopausal patients, as well as the impact on acceptability and feasibility. METHODS We conducted a prospective, randomized study of people eligible for cervical cancer screening, stratified by menopausal status, to undergo standard written or telehealth-based instructions for hrHPV self-collection. English speaking individuals residing in Oregon, with a cervix, eligible for primary hrHPV testing, and with access to a video-capable device were included. Patients with prior hysterectomy, trachelectomy, diagnosis of cervical cancer, or pelvic radiation for gynecologic cancer were excluded. We compared preference for and opinions about self-collection and hrHPV test results, by randomization group and stratified by menopausal status using descriptive statistics. RESULTS Among 123 patients enrolled, 61 identified as post-menopausal with a median age of 57 years. While the majority of post-menopausal participants who received telehealth instructions found it helpful, only 6.1% considered telehealth instructions necessary to complete self-testing. There was no difference in opinion of telehealth by menopausal status. Overall, 88.5% of post-menopausal participants preferred self-collection to provider-collection. There were no significant differences between pre- and post-menopausal participants in terms of test preference, discomfort, ease of use, or perceptions of self-collection. CONCLUSION Telehealth instruction did not add significant value to patients participating in hrHPV self-collection, nor did it alter the acceptability of hrHPV-self collection among an English-speaking cohort. Compared with prior experiences with provider-collected screening, hrHPV self-collection was preferred by both pre- and post-menopausal participants. There were no significant differences in preference for provider- versus self-collection when stratified by menopausal status.
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Affiliation(s)
- Katherine Fitch
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
| | - Jacqueline A Bohn
- Department of Obstetrics & Gynecology, University of Oklahoma, Norman, Oklahoma, USA
| | - Jenna B Emerson
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
| | - Emily R Boniface
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, OHSU, Portland, Oregon, USA
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Rebolj M, Sargent A, Njor SH, Cuschieri K. Widening the offer of human papillomavirus self-sampling to all women eligible for cervical screening: Make haste slowly. Int J Cancer 2023; 153:8-19. [PMID: 36385698 PMCID: PMC10952475 DOI: 10.1002/ijc.34358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high-income countries with long-standing, organised cervical screening programmes, self-collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under- and well-screened women. For these contexts, a validated microsimulation model determined that adding self-collection to clinician collection is likely to be cost-effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We used these thresholds to review the 'early-adopter' programme-level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among underscreened women was accompanied by a high rate of substituting clinician sampling with self-collection among well-screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self-sampling vs clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a follow-up triage test that required a clinician sample. To support real-world programmes on their pathways toward implementation and to avoid HPV self-collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Alexandra Sargent
- Cytology Department, Manchester Royal InfirmaryManchester University NHS Foundation TrustManchesterUK
| | - Sisse Helle Njor
- University Research Clinic for Cancer Screening, Department of Public Health ProgrammesRanders Regional HospitalRandersDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian ScotlandEdinburghUK
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Njor SH, Søborg B, Tranberg M, Rebolj M. Concurrent participation in breast, cervical, and colorectal cancer screening programmes in Denmark: A nationwide registry-based study. Prev Med 2023; 167:107405. [PMID: 36581010 PMCID: PMC10265133 DOI: 10.1016/j.ypmed.2022.107405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022]
Abstract
Women in Denmark are invited to breast, cervical, and colorectal cancer screening in their fifties and sixties. We determined the patterns of concurrent participation in the three programmes. Participation in organised cancer screening was determined using the highly complete Danish population and health care registers for all women aged 53-65 years on 31 March 2018 who continuously resided in Denmark since 1 April 2012. Data were linked using unique personal identification numbers. We studied overall and cancer-specific proportions of women undergoing screening for all three, two, one, and none of the cancers. Among all 468,507 women, 406,306 (87%) participated in breast, 345,768 (74%) in cervical, and 316,496 (68%) in colorectal cancer screening. Despite high participation, only 255,698 (55%) women were screened for all three cancers, while 123,469 (26%) were screened for two, 54,538 (12%) for one, and 34,802 (7%) were not screened for any cancer. Cancer-specific patterns were highly heterogeneous across the population but changed little after accounting for women's medical history. A significant proportion of women who are screened for a specific cancer remain unscreened for other cancers. The consistency of these data at the international level requires a reconsideration of invitational practices for organised screening.
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Affiliation(s)
- Sisse Helle Njor
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Bo Søborg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Mette Tranberg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
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Drysdale H, Marlow LAV, Lim A, Sasieni P, Waller J. Self-sampling for cervical screening offered at the point of invitation: A cross-sectional study of preferences in England. J Med Screen 2022; 29:194-202. [PMID: 35389282 PMCID: PMC9381689 DOI: 10.1177/09691413221092246] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study assessed preferences for human papillomavirus (HPV) self-sampling if offered as an alternative to clinician-based screening at the point of invitation for cervical screening. SETTING AND METHODS An online questionnaire was completed by screening-eligible women living in England (n = 3672). Logistic regressions explored associations between demographic characteristics and screening preferences, stratified by previous screening attendance. Reasons for preferences were also assessed. RESULTS Half of participants (51.4%) intended to choose self-sampling, 36.5% preferred clinician screening, 10.5% were unsure, and <2% preferred no screening. More irregular and never attenders chose self-sampling, compared with regular attenders (71.1% and 70.1% vs. 41.0% respectively). Among regular attenders, self-sampling was preferred more frequently by the highest occupational grade, older and lesbian, gay and bisexual women, and those with experience of blood self-tests. In the irregular attender group, older women and those with experience of blood self-tests were more likely to choose self-sampling. In 'never attenders', self-sampling was less popular in ethnic minority groups. CONCLUSIONS If offered a choice of screening, around half of women in England may choose self-sampling, but a substantial proportion would still opt for clinician screening. Screening providers will need to manage a high take-up of self-sampling if many regular attenders switch to self-sampling.
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Affiliation(s)
- Hannah Drysdale
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Laura AV Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Anita Lim
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Peter Sasieni
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
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Shiraz A, Egawa N, Pelt DM, Crawford R, Nicholas AK, Romashova V, Sasieni P, Griffin H, Doorbar J. Cervical cell lift: A novel triage method for the spatial mapping and grading of precancerous cervical lesions. EBioMedicine 2022; 82:104157. [PMID: 35863292 PMCID: PMC9301573 DOI: 10.1016/j.ebiom.2022.104157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Primary HPV screening, due to its low specificity, requires an additional liquid-based cytology (LBC) triage test. However, even with LBC triage there has been a near doubling in the number of patients referred for colposcopy in recent years, the majority having low-grade disease. METHODS To counter this, a triage test that generates a spatial map of the cervical surface at a molecular level has been developed which removes the subjectivity associated with LBC by facilitating identification of lesions in their entirety. 50 patients attending colposcopy were recruited to participate in a pilot study to evaluate the test. For each patient, cells were lifted from the cervix onto a membrane (cervical cell lift, CCL) and immunostained with a biomarker of precancerous cells, generating molecular maps of the cervical surface. These maps were analysed to detect high-grade lesions, and the results compared to the final histological diagnosis. FINDINGS We demonstrated that spatial molecular mapping of the cervix has a sensitivity of 90% (95% CI 69-98) (positive predictive value 81% (95% CI 60-92)) for the detection of high-grade disease, and that AI-based analysis could aid disease detection through automated flagging of biomarker-positive cells. INTERPRETATION Spatial molecular mapping of the CCL improved the rate of detection of high-grade disease in comparison to LBC, suggesting that this method has the potential to decisively identify patients with clinically relevant disease that requires excisional treatment. FUNDING CRUK Early Detection Project award, Jordan-Singer BSCCP award, Addenbrooke's Charitable Trust, UK-MRC, Janssen Pharmaceuticals/Advanced Sterilisation Products, and NWO.
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Affiliation(s)
- Aslam Shiraz
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK; Department of Gynae-Oncology, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Nagayasu Egawa
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Daniël M Pelt
- Leiden Institute of Advanced Computer Science (LIACS), Leiden University, Niels Bohrweg 1, 2333 CA Leiden, the Netherlands
| | - Robin Crawford
- Department of Gynae-Oncology, Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Adeline K Nicholas
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Veronika Romashova
- Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, Puddicombe Way, Cambridge, CB2 0AW, UK
| | - Peter Sasieni
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Heather Griffin
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - John Doorbar
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK.
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Landy R, Hollingworth T, Waller J, Marlow LA, Rigney J, Round T, Sasieni PD, Lim AW. Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial. Br J Gen Pract 2022; 72:e26-e33. [PMID: 34972808 PMCID: PMC8714504 DOI: 10.3399/bjgp.2021.0350] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cervical cancer disproportionately affects women ≥65 years, especially those not screened regularly. Speculum use is a key barrier. AIM To assess if offering non-speculum clinician-taken sampling and self-sampling increases uptake for lapsed attenders aged 50-64 years. DESIGN AND SETTING Pragmatic randomised control trial conducted at 10 general practices in East London, UK. METHOD Participants were 784 women aged 50-64 years, last screened 6-15 years before randomisation. Intervention participants received a letter offering the choice of non-speculum clinician- or self-sampling. Control participants received usual care. The main outcome measure was uptake within 4 months. RESULTS Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (n = 80/393) versus 4.9% in the control arm (n = 19/391, absolute difference 15.5%, 95% confidence interval [CI] = 11.0% to 20.0%, P<0.001). This was maintained at 12 months: intervention 30.5% (n = 120/393) versus control 13.6% (n = 53/391) (absolute difference 17.0%, 95% CI = 11.3% to 22.7%, P<0.001). Conventional screening attendance within 12 months was very similar for both intervention 12.7% (n = 50/393) and control 13.6% (n = 53/391) arms. Ethnic differences were seen in screening modality preference. More White women opted for self-sampling (50.7%, n = 38/75), whereas most Asian and Black women and those from other ethnic backgrounds opted for conventional screening. CONCLUSION Offering non-speculum clinician-taken sampling and self-sampling substantially increases uptake in older lapsed attendee women. Non-speculum clinician sampling appeals to women who dislike the speculum but still prefer a clinician to take their sample. Providing a choice of screening modality may be important for optimising cervical screening uptake.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, US
| | | | - Jo Waller
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Laura Av Marlow
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Jane Rigney
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London and National Cancer Analysis and Registration Service, Public Health England
| | - Peter D Sasieni
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Anita Ww Lim
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
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Tiiti TA, Mashishi TL, Nkwinika VV, Molefi KA, Benoy I, Bogers J, Selabe SG, Lebelo RL. Evaluation of ILEX SelfCerv for Detection of High-Risk Human Papillomavirus Infection in Gynecology Clinic Attendees at a Tertiary Hospital in South Africa. J Clin Med 2021; 10:jcm10214817. [PMID: 34768334 PMCID: PMC8584638 DOI: 10.3390/jcm10214817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The SelfCerv Self-Collection Cervical Health Screening Kit (Ilex Medical Ltd., Johannesburg, South Africa) is an applicator tampon designed for self-collection of vaginal samples for the detection of human papillomavirus (HPV) deoxyribonucleic acid (DNA) and E6/E7 messenger ribonucleic acid (mRNA). The study aimed to evaluate the performance of the SelfCerv applicator tampon for the detection of hr-HPV for cervical cancer screening, and further to investigate women's experiences and preferences regarding self-sampling. METHODS Vaginal samples were collected from 527 gynecology clinic attendees aged ≥18 years at a tertiary hospital in Gauteng Province, South Africa. Self-samples were collected using the SelfCerv kit, followed by endocervical samples collected by a healthcare professional using Cervex-Brush® Combi. Participants completed a self-administered questionnaire on self-sampling experiences and preferences. Both samples were tested for 14 high-risk (hr) HPV types and E6/E7 mRNA using the Abbott RealTime HR-HPV and Aptima HR-HPV mRNA assays, respectively. RESULTS The overall agreement for hr-HPV typing between 527 paired samples was good (87.1%; κ =0.74) with high sensitivity (86.2%) and specificity (88.0%). HPV-16 (96.4%; κ = 0.83) had higher agreement rate than HPV-18 (96.8%; κ = 0.72) and the other 12 hr-HPVs (86.5%; κ = 0.72). Two hundred and eighty-five (285) sample pairs tested for E6/E7 mRNA showed fair agreement (70.2%; κ= 0.34). Furthermore, self-sampling was reported as comfortable (90.5%) and painless (86.7%), with 88.4% of women preferring self-collection. CONCLUSIONS Self-collected samples had good agreement with the healthcare professional-collected samples for the detection of hr-HPV DNA and the procedure was highly preferred by women. Self-sampling using SelfCerv can be used as an alternative to healthcare professional sampling in clinic-based routine cervical cancer screening.
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Affiliation(s)
- Teboho Amelia Tiiti
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
| | - Tebogo Loraine Mashishi
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Kgotlaethata Aaron Molefi
- Department of Obstetrics and Gynaecology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Ina Benoy
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, 2020 Antwerpen, Belgium
| | - Johannes Bogers
- Laboratory of Cell Biology and Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerpen, Belgium; (I.B.); (J.B.)
- Algemeen Medisch Laboratorium (AML), Sonic Healthcare, 2020 Antwerpen, Belgium
- Department of Anatomical Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Selokela Gloria Selabe
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- National Health Laboratory Service, Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Ramokone Lisbeth Lebelo
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; (T.A.T.); (T.L.M.); (V.V.N.); (S.G.S.)
- South African Vaccination and Immunization Centre, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- National Health Laboratory Service, Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Correspondence: ; Tel.: +27-12521-3038
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Phoolcharoen N, Kantathavorn N, Krisorakun W, Taepisitpong C, Krongthong W, Saeloo S. Acceptability of Self-Sample Human Papillomavirus Testing Among Thai Women Visiting a Colposcopy Clinic. J Community Health 2019; 43:611-615. [PMID: 29302852 DOI: 10.1007/s10900-017-0460-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We offered self-sampling devices to 250 women who visited the colposcopy clinic at Chulabhorn Hospital, Bangkok, Thailand from March 1 to June 30, 2015. Participants received instruction about the vaginal self-sample method and collected the specimen themselves, before being examined by the physician who obtained a conventional cervical specimen. Participating women's attitudes and feelings regarding the self-sample method were explored using a short questionnaire. Of the 247 eligible women, more than 90% of participants rated the self-sample method as very good to excellent for convenience, comfort, and safety. In addition, 80% of participants reported the overall experience of using the self-sample device was very good to excellent compared with the physician-collected method. Self-sample HPV testing appears to be highly accepted and perceived as convenient, comfortable, and safe. More studies on self-sample HPV testing should be conducted in Thailand to investigate this as an alternative method of cervical cancer screening, particularly among women who do not attend the screening program.
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Affiliation(s)
- Natacha Phoolcharoen
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
| | - Nuttavut Kantathavorn
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wasanai Krisorakun
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chantanee Taepisitpong
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Waraphorn Krongthong
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Siriporn Saeloo
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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El-Zein M, Bouten S, Louvanto K, Gilbert L, Gotlieb WH, Hemmings R, Behr MA, Franco EL. Predictive Value of HPV Testing in Self-collected and Clinician-Collected Samples Compared with Cytology in Detecting High-grade Cervical Lesions. Cancer Epidemiol Biomarkers Prev 2019; 28:1134-1140. [PMID: 31015201 DOI: 10.1158/1055-9965.epi-18-1338] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/11/2019] [Accepted: 04/11/2019] [Indexed: 11/16/2022] Open
Abstract
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 = 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+ 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-US+) 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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Affiliation(s)
- Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, Canada.
| | - Sheila Bouten
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Karolina Louvanto
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Lucy Gilbert
- Gynecologic Cancer Service, McGill University Health Centre - Glen Site Cedars Cancer Centre, Montreal, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology and Colposcopy, McGill University - Jewish General Hospital, Montreal, Canada
| | - Robert Hemmings
- Department of Obstetrics and Gynecology, McGill University Health Centre - St. Mary's Hospital Centre, Montreal, Canada
| | - Marcel A Behr
- Department of Microbiology, McGill University Health Centre, Montreal, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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Cuschieri K, Lorincz AT, Nedjai B. Human Papillomavirus Research: Where Should We Place Our Bets? Acta Cytol 2019; 63:85-96. [PMID: 30921789 DOI: 10.1159/000493800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Massive strides have been made with respect to primary and secondary prevention of human papillomavirus (HPV)-associated disease as a result of prophylactic vaccination and cervical screening based on molecular HPV testing. However, cervical cancer continues to be an important clinical and societal burden. Additionally, other HPV-associated cancers, for which there are no screening programmes, are rising. Finally, the optimal combination of vaccination and screening strategies will require careful thinking. Considering this unprecedented and important time, we were keen to solicit the views of the expert community to determine what they perceived were the key priorities for HPV research. Our objective was to identify consensus and key priorities for HPV-based research through provision of a questionnaire disseminated to a multidisciplinary group of key opinion leaders (KOLs). SUMMARY A structured survey composed of 46 HPV research "categories" was sent to 73 KOLs who were invited to "rank" the categories according to priority. The invitees represented clinical and public health disciplines as well as basic scientists. Scores were weighted according to the number of responses. Invitees also had the opportunity to comment on barriers to the research and suggest other research areas that required attention not reflected in the survey. We received 29 responses in total; overall, the 3 highest-ranked categories were "optimal cervical screening in low and middle-income countries (LMICs)," "primary disease prevention in LMICs" and "impact of vaccine on HPV infection and associated disease." "HPV and the microbiome" and "mechanisms of transformation" were the highest-ranked categories with respect to basic research. Consistent barriers to research were around governance on the use of samples and data and funding, particularly in an era of vaccination. Key Messages: Research to support the management of disease in LMICs is clearly perceived as a priority in the international community in addition to other diverse areas which necessitate an improved basic understanding of viral mechanisms and interactions. International, multidisciplinary efforts which articulate the broader HPV research agenda will be important when seeking funding in addition to international endeavours to support the efficient use of existing samples and cohorts to facilitate such research.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Attila T Lorincz
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, Barts and the London School of Medicine, London, United Kingdom,
| | - Belinda Nedjai
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Queen Mary University of London, Barts and the London School of Medicine, London, United Kingdom
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15
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Acceptability, Feasibility and Uptake of HPV Self-Sampling Among Immigrant Minority Women: a Focused Literature Review. J Immigr Minor Health 2018; 21:1380-1393. [DOI: 10.1007/s10903-018-0846-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bennett KF, Waller J, Chorley AJ, Ferrer RA, Haddrell JB, Marlow LAV. Barriers to cervical screening and interest in self-sampling among women who actively decline screening. J Med Screen 2018; 25:211-217. [PMID: 29649936 PMCID: PMC6262593 DOI: 10.1177/0969141318767471] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/07/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Understanding why some women actively decline cervical screening could contribute to tailored intervention development. We explored reasons for non-participation in cervical screening among women who had made an active decision not to attend in the future. We also explored interest in human papillomavirus self-sampling. METHODS In a population-based survey of women in Great Britain, home-based computer-assisted interviews were carried out with screening eligible women. Women reported their intention to attend for screening when next invited. They endorsed predefined barriers to screening and indicated their interest in human papillomavirus self-sampling. RESULTS Women who had actively declined screening and those who intended to go but were currently overdue (n=543) were included in this analysis. Women who had made an active decision not to be screened in the future were more likely to endorse the barriers 'I have other more important things to worry about' and to perceive screening to be of low relevance based on their sexual behaviour. Most participants (70%) indicated that they would be interested in human papillomavirus self-sampling. Interest in self-sampling was greater among those who reported having had a bad experience of screening in the past, were too busy or embarrassed to attend, or would not want a man to carry out the test. CONCLUSIONS Women who had made an active decision not to attend screening felt it was of low relevance to them and that they had more important things to worry about. Shifting the perceived cost-benefit ratio for these women by offering human papillomavirus self-sampling might increase screening participation in this group.
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Affiliation(s)
- Kirsty F Bennett
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Amanda J Chorley
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Jessica B Haddrell
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
| | - Laura AV Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, London, UK
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17
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Arbyn M, Peeters E, Benoy I, Vanden Broeck D, Bogers J, De Sutter P, Donders G, Tjalma W, Weyers S, Cuschieri K, Poljak M, Bonde J, Cocuzza C, Zhao FH, Van Keer S, Vorsters A. VALHUDES: A protocol for validation of human papillomavirus assays and collection devices for HPV testing on self-samples and urine samples. J Clin Virol 2018; 107:52-56. [PMID: 30195193 DOI: 10.1016/j.jcv.2018.08.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/09/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACK GROUND Systematic reviews have concluded that hrHPV DNA testing using target-amplification tests is as accurate on vaginal self-samples as on clinician-taken specimens for the detection of cervical precancer. However, insufficient evidence is available for specific HPV assay/self-sample device combinations. OBJECTIVES The VALHUDES protocol is designed as a diagnostic test accuracy study that aims to compare the clinical sensitivity and specificity of particular hrHPV assay(s) on vaginal self-samples and first-void-urine, collected in agreement with standardized protocols, with hrHPV testing on matched clinician-taken samples. STUDY DESIGN Five hundred enrolled women referred to a colposcopy clinic are invited to collect a first-void urine sample and one or more vaginal self-samples with particular devices before collection of a cervical sample by a clinician. Sample sets are subsequently analysed in a laboratory accredited for HPV testing. Disease verification for all enrolled patients is provided by colposcopy combined with histological assessment of biopsies. RESULTS A first VALHUDES study has started in Belgium in December 2017 with enrolment from four colposcopy centres. The following assays are foreseen to be evaluated: RealTime High Risk HPV assay (Abbott), cobas-4800 and -6800 (Roche), Onclarity (BD), Xpert HPV (Cepheid) and Anyplex II HPV HR (Seegene). CONCLUSION Given empirical evidence that the relative accuracy of HPV-testing on self- vs clinician-samples is robust across clinical settings, the VALHUDES protocol offers a framework for validation of HPV assay/self-sample device combinations that can be translated to a primary screening setting.
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Affiliation(s)
- M Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
| | - E Peeters
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - I Benoy
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium; National Reference Centre for HPV, Brussels, Belgium; AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | - D Vanden Broeck
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium; National Reference Centre for HPV, Brussels, Belgium; AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium; International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - J Bogers
- Laboratory of Molecular Pathology, AML Sonic Healthcare, Antwerp, Belgium; National Reference Centre for HPV, Brussels, Belgium; AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium; International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - P De Sutter
- UZ Brussel - VUB, dept Gynaecology-Oncology, Brussels, Belgium
| | - G Donders
- Department of Obstetrics and Gynaecology of the General Regional Hospital Heilig Hart, Tienen, Belgium; Femicare vzw, Clinical Research for Women, Tienen, Belgium; Department of Obstetrics and Gynaecology University Hospital Antwerpen, Antwerp, Belgium
| | - W Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital (UZA), Edegem, Belgium; Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - S Weyers
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - K Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, United Kingdom
| | - M Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - J Bonde
- Molecular Pathology Laboratory, Dept. Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - C Cocuzza
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - F H Zhao
- Department of Epidemiology, Cancer Institute of Chinese Academy of Medical Sciences, Peking Union Medical College, Department of Gynaecology and Obstetrics, Beijing Tongeren Hospital, Beijing, China
| | - S Van Keer
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk (Antwerp), Belgium
| | - A Vorsters
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk (Antwerp), Belgium
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Andersson S, Belkić K, Mints M, Östensson E. Is self-sampling to test for high-risk papillomavirus an acceptable option among women who have been treated for high-grade cervical intraepithelial neoplasia? PLoS One 2018; 13:e0199038. [PMID: 29912903 PMCID: PMC6005489 DOI: 10.1371/journal.pone.0199038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Self-sampling to test for high risk human papilloma virus (HPV) is becoming an increasingly important component of cervical cancer screening. The aim of this observational study is to examine how women treated for high-grade cervical intraepithelial neoplasia (CIN) view HPV self-sampling. Methods Invited to participate in the present study were patients who had undergone treatment of high-grade CIN (grade 2 or higher) and were followed-up at 6-months at the Karolinska University Hospital, Stockholm. The participants were instructed as to how to perform HPV self-sampling. Thereafter, the participants completed a questionnaire about HPV self-sampling and other cervical cancer screening methods, as well as about self-perceived risk of cervical cancer without regular gynecologic follow-up and about specific knowledge regarding HPV, CIN and cervical cancer. Results Altogether 479 women enrolled in this study. The participation rate was 96.6%. Nearly 75% of the participants stated they would consider performing the HPV self-sampling prior to their next gynecologic follow-up. Confidence in HPV self-sampling was a significant independent predictor of willingness to perform HPV self-sampling. However, confidence in HPV self-sampling was significantly lower than confidence in Papanicolaou smears and in HPV testing with samples collected by health professionals. Higher specific knowledge about HPV, CIN and cervical cancer was also a significant independent predictor of willingness to perform HPV self-sampling, as was having travelled longer distance to attend gynecologic follow-up. Participants with lower income and without completed university education expressed significantly higher confidence in HPV self-sampling and lower confidence in Papanicolaou smears than the other women. Conclusions To the best of our knowledge, this is the first study to examine the views of women treated for high-grade CIN vis-à-vis HPV self-sampling. The latter is an acceptable option for the vast majority of this cohort of women.
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Affiliation(s)
- Sonia Andersson
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Karen Belkić
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- School of Community and Global Health, Claremont Graduate University, Claremont, California, United States of America
- Institute for Prevention Research, Keck School of Medicine, University of Southern California, Alhambra, California, United States of America
| | - Miriam Mints
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Ellinor Östensson
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- * E-mail:
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Gupta S, Palmer C, Bik EM, Cardenas JP, Nuñez H, Kraal L, Bird SW, Bowers J, Smith A, Walton NA, Goddard AD, Almonacid DE, Zneimer S, Richman J, Apte ZS. Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Front Public Health 2018; 6:77. [PMID: 29686981 PMCID: PMC5900042 DOI: 10.3389/fpubh.2018.00077] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/01/2018] [Indexed: 12/23/2022] Open
Abstract
In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample will visit a clinic for follow-up diagnosis and management. In addition, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zachary S Apte
- uBiome, San Francisco, CA, United States.,University of California San Francisco, San Francisco, CA, United States
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20
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Phoolcharoen N, Kantathavorn N, Krisorakun W, Sricharunrat T, Teerayathanakul N, Taepisitpong C, Sornsamdang G, Krongthong W, Saeloo S. Agreement of self- and physician-collected samples for detection of high-risk human papillomavirus infections in women attending a colposcopy clinic in Thailand. BMC Res Notes 2018; 11:136. [PMID: 29458440 PMCID: PMC5819229 DOI: 10.1186/s13104-018-3241-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/09/2018] [Indexed: 11/10/2022] Open
Abstract
Objective To study the concordance between vaginal self- and endocervical physician-collected high-risk (hr) HPV testing in Thai women who attended a colposcopy clinic. Vaginal samples were obtained by self-sampling with a dry brush before endocervical samples were obtained by physicians. Both specimens were analyzed for hrHPV by Cobas4800 HPV test. Results Of the 247 pairs of samples, overall hrHPV prevalence from self- and physician-collected samples was 41.3 and 36.0%, respectively. The overall agreement between the methods was 74.5% with κ 0.46 (P < 0.001). Our study revealed moderate agreement between self- and physician-collected methods for hrHPV testing.
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Affiliation(s)
- Natacha Phoolcharoen
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand. .,Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
| | - Nuttavut Kantathavorn
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wasanai Krisorakun
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Thaniya Sricharunrat
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Narongchai Teerayathanakul
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chantanee Taepisitpong
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Gaidganok Sornsamdang
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Waraphorn Krongthong
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Siriporn Saeloo
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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21
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Lam JUH, Rebolj M, Møller Ejegod D, Pedersen H, Rygaard C, Lynge E, Thirstrup Thomsen L, Krüger Kjaer S, Bonde J. Human papillomavirus self-sampling for screening nonattenders: Opt-in pilot implementation with electronic communication platforms. Int J Cancer 2017; 140:2212-2219. [PMID: 28195317 PMCID: PMC5516138 DOI: 10.1002/ijc.30647] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/23/2017] [Accepted: 02/01/2017] [Indexed: 01/23/2023]
Abstract
In organized cervical screening programs, typically 25% of the invited women do not attend. The Copenhagen Self‐sampling Initiative (CSi) aimed to gain experiences on participation among screening nonattenders in the Capital Region of Denmark. Here, we report on the effectiveness of different communication platforms used in the pilot with suggestions for strategies prior to a full‐implementation. Moreover, an innovative approach using self‐sampling brushes with unique radio frequency identification chips allowed for unprecedented levels patient identification safety. Nonattenders from the capital region of Denmark were identified via the organized national invitation module. Screening history was obtained via the nationwide pathology registry. Twenty‐four thousand women were invited, and as an alternative to the regular communication platforms (letter and phone), women could request a home test via a mobile‐friendly webpage. Instruction material and video‐animation in several languages were made available online. Chi‐square test was used to test differences. Out of all invited, 31.7% requested a home test, and 20% returned it to the laboratory. In addition, 10% were screened at the physician after receiving the invitation. Stratified by screening history, long‐term unscreened women were less likely to participate than intermittently screened women (28% vs. 16%, p < 0.001). Of all contacts received, 64% (63–65) came via letter, and 31% (95CI: 30–32%) via webpage/mobile‐app. Self‐sampling was well‐accepted among nonattenders. Adopting modern technology‐based platforms into the current organized screening program would serve as a convenient communication method between health authority and citizens, allowing easy access for the citizen and reducing the work load in administrating self‐sampling approaches. What's new? Our implementation study is the first to evaluate opt‐in self‐sampling for 24,000 screening nonattenders, which can be basis for future routine implementation. Women could respond through a variety of communication channels (regular mail, phone and custom‐made web/mobile‐app). Our study utilized self‐sampling brushes with a novel RFID‐chip for secure patient‐identification, eliminating inconveniences for the women to fill out forms on returning the brush and loss of brushes due to missing identification.
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Affiliation(s)
- Janni Uyen Hoa Lam
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Matejka Rebolj
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Helle Pedersen
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Carsten Rygaard
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Susanne Krüger Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.,Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
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