Comparison of natural histories of human papillomavirus detected by clinician- and self-sampling

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Abstract
New strategies for cervical cancer screening include human papillomavirus (HPV) DNA testing. Using self‐testing methods would increase access to testing in both developed and developing countries. The purpose of this study was to compare time‐to‐clearance of specific HPV types between clinician‐collected‐lavage (CC‐L) and self‐collected (SC) sampling in a single cohort. CC‐L and SC samples were obtained every 4 months at alternate 2‐month windows from 537 women. Eighteen high‐risk (HR) HPV and 4 low‐risk (LR) HPV were examined. Proportional hazards model was used to compare time‐to‐clearance between methods for combined HR and for 13 specific HPV types. Prentice‐Wilcoxon test was used for within‐subject paired comparison. In the independent analysis for combined HR and LR types, no differences were found. For specific types, time‐to‐clearance for all HPV types examined between CC‐L and SC samples was similar except for HPV 66 which showed a trend to clear slower by SC (p = 0.09). When comparing methods in the same woman, time‐to‐clearance was similar for all types except for HPV 16 which showed a trend to clear slower by CC‐L means (p = 0.08). When we examined pattern of clearance among the CC‐L samples, the fastest types to clear were HPV 6, 18, 66, 84 and 39 and the slowest were HPV 62, 68, 59 and 16. These patterns of fast and slow were similar for SC samples. Our findings suggest using SC vaginal swabs would observe similar natural histories of HPV compared to studies using CC‐L specimens making self‐testing feasible for repeated HPV DNA detection.