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Home Screening and Treatment Testing and Treatment Self-Sampling for Pap Tests May Be Feasible

Self-Sampling for Pap Tests May Be Feasible

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Pap and HPV tests done with self-collected cell samples rival those done with physician-collected specimens in detecting cervical lesions and may offer new opportunities for screening in underserved populations, a new study reports.

Cervical cancer strikes approximately 11,000 women in the U.S each year, and causes 3,900 deaths, numbers that seem especially tragic considering the disease is preventable through screening and early detection. According to the American Cancer Society, the majority of cervical cancers occur among women who have either never had a Pap test, or have gone many years without one.

The disease burden is especially high among the poor and in communities of color: compared to non-Hispanic white women, Hispanic women are twice as likely to be diagnosed with the disease, and African-Americans with cervical cancer are twice as likely to die as a result. The disparities most likely stem from a combination of social and cultural factors, including a lack of access to health care.

In a study done by Dr. Israel De Alba and colleagues from the University of California-Irvine, self-collection kits were given to Hispanic women in Orange County, CA. The women were provided with instructions in Spanish and directed to insert a cotton-tipped swab as far as possible into the vagina, and to rotate it five times in either direction. Pap tests and “high risk” HPV tests were done with samples from 1,213 women. From this group, 662 women also had a Pap test done with a provider-collected sample, and about half of these were also tested for HPV.

Compared to provider-collected specimens, Pap tests done with self-collected samples were slightly more sensitive, or better in detecting abnormal cervical cell changes (50% for provider vs. 55% for self-collected). Specificity (avoiding false positive results), however, was only 79% with self-collection, compared to 94% with provider-collected cell samples. The authors say this may result from self-sampling being more likely to detect vaginal infections.  

Importantly, nearly two-thirds of women in the study rated the experience of collecting their own cell samples as “excellent” or “very good”. The authors conclude that unsupervised sampling is not only reliable, but may also help disadvantaged women address logistical obstacles to clinic visits such as time and transportation. Some experts do caution that low specificity with self-sampling may result in a higher number of false positives, with the attendant costs of colposcopic follow up, and psychosocial distress.

American Cancer Society, Detailed Guide: Cervical Cancer.
National Cancer Institute, SEER Cancer Statistics Review, 1975-2004) (Ries LAG, et al (eds).
De Alba I, et al. Self-sampling for human papillomavirus in a community setting: feasibility study in Hispanic women. Cancer Epidemiology Biomarkers & Prevention 2008. 17: 2163-68.