Journal of Indira Gandhi Institute Of Medical Sciences

LETTER TO EDITOR
Year
: 2022  |  Volume : 8  |  Issue : 1  |  Page : 73--74

HPV self-sampling: A viable option for cervical cancer screening in postpandemic era


Jyotsna Rani, Kavya Abhilashi, Pratibha Kumari, Satya Kumari 
 Department of Gynecological Oncology, IGIMS, Patna, Bihar, India

Correspondence Address:
Jyotsna Rani
Department of Gynecological Oncology, IGIMS, Patna, Bihar
India




How to cite this article:
Rani J, Abhilashi K, Kumari P, Kumari S. HPV self-sampling: A viable option for cervical cancer screening in postpandemic era.J Indira Gandhi Inst Med Sci 2022;8:73-74


How to cite this URL:
Rani J, Abhilashi K, Kumari P, Kumari S. HPV self-sampling: A viable option for cervical cancer screening in postpandemic era. J Indira Gandhi Inst Med Sci [serial online] 2022 [cited 2022 Oct 5 ];8:73-74
Available from: http://www.jigims.co.in/text.asp?2022/8/1/73/338360


Full Text



Dear Editor,

This is irony that despite being preventable disease, cervical cancer is the fourth-most common cancer in women worldwide whereas the second-most common cancer among Indian females.[1] Although screening tests aimed at detection of precancerous and early cancerous lesions have been shown to decrease the incidence of disease and mortality caused by it, lack of organized screening program at national level and its meager access to rural and vulnerable population has been remain a giant obstacle in elimination of cervical cancer.

In low- and middle-income countries (LMICs) or resource-limited settings, visual inspection with acetic acid is recommended and used as an alternative cost-effective screening strategy but associated with high overtreatment rates. Since human papillomavirus (HPV) infection is now an established cause of cervical cancer in almost 99.7% of cases, primary hrHPV testing or co-testing is a preferable option for screening cervical precancerous and cancerous lesions. The most important issue for hrHPV testing in primary cervical cancer screening is to detect persistent or clinically relevant infections that will develop into CIN2 or higher and to differentiate them from transient HPV infections which get cleared off spontaneously to avoid unnecessary or excessive follow-up.

In recent years, an alternative method of HPV testing from self-collected samples has been used to improve access to cervical cancer screening. Self-sampling offers opportunity to women of even remote areas to get screened for cervical cancer by a highly sensitive test. Furthermore, self-sampling respects women's privacy, omits the pelvic examination and associated discomfort, and saves time and the need for traveling or permission from family members to attend the clinic. Self-sampling is easy to perform and women of any age group can do it after going through its written instructions.

In various studies for self-sampling, a wide variety of devices such as cervicovaginal brushes, vaginal swabs, tampon-like devices, and lavage devices have been employed for collecting exfoliated cells of the cervicovaginal canal for subsequent HPV DNA detection. First-void urine collection for hrHPV testing may be an alternative and easy-to-collect approach of self-sampling for HPV testing but associated with lower diagnostic accuracy.[2],[3]

Self-sampling is cost-effective, convenient, and less painful than a Pap test or clinician-sampled HPV test. This has been suggested by a pooled analysis of 38 studies in LMICs in which most participants found self-sampling as easy to perform (75%–97%, 18 studies), painless (60%–90%, 9 studies), and preferred clinician-collected sampling (57%–100%, 14 studies).[4] It also offers advantage of extending the screening interval of 5 years following negative results.

COVID-19 has disrupted the cervical screening services significantly, and in this postpandemic phase, HPV self-sampling seems a suitable option for cervical cancer screening. This can be detrimental in cervical cancer elimination by accelerating the uptake of screening services among women. However, the target population needs prior information and education to perform this test in a correct way. Further, availability of organized screening programs such as community-based approaches and linkage to follow-up care are crucial before considering self-sampling as a component of a cervical cancer-screening strategy in low-resource settings.

Self-sampling shows good agreement for the detection of hrHPV, with sensitivity of 91.4%–96.8% in the studies comparing self-samples with samples collected by clinicians. However, there are women who prefer sample collection by clinicians as it gives them more satisfaction after being examined and receiving clinical comment by a doctor. Some studies in LMICs found women geared of hurting themselves and expressed the need for assistance with self-sampling. A study in rural population of South India has shown feasibility and acceptance of HPV self-sampling for cervical cancer screening among the local population, and this can be taken up on a larger scale in various regions of country, especially in this postpandemic phase, when restrictions and hesitation are not taken off completely.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.
2Kamath Mulki A, Withers M. Human papilloma virus self-sampling performance in low – And middle-income countries. BMC Womens Health 2021;21:12.
3Bais AG, van Kemenade FJ, Berkhof J, Verheijen RH, Snijders PJ, Voorhorst F, et al. Human papillomavirus testing on self-sampled cervicovaginal brushes: An effective alternative to protect nonresponders in cervical screening programs. Int J Cancer 2007;120:1505-10.
4Lazcano-Ponce E, Lorincz AT, Cruz-Valdez A, Salmerón J, Uribe P, Velasco-Mondragón E, et al. Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): A community-based randomised controlled trial. Lancet 2011;378:1868-73.
5Madhivanan P, Nishimura H, Ravi K, Pope B, Coudray M, Arun A, et al. Acceptability and concordance of self- versus clinician – Sampling for HPV testing among rural South Indian women. Asian Pac J Cancer Prev 2021;22:971-6.