Primary screening for cervical cancer through self sampling

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Abstract
Objective: To evaluate the use of community health agents (CHAs) to instruct women living in poor rural areas in obtaining self-collected cervical samples and compare the high-risk HPV (hrHPV) hybrid capture (HC) results obtained to those for gynecologist-collected samples. Methods: After a one-day training, CHAs visited sexually active women, instructing each in the use of collection brush and the Universal Collection Medium tube. One week thereafter, a gynecologist collected cervical samples from, and performed colposcopies on, the same women. A single reference Lab performed all HCs. Results: 878 women (Age: 15-69 years) participated. Among self-collected samples, hrHPV prevalence was 33.9% (95% CI: 30.8%-37%), compared with 28.6% (95% CI: 27%-30%) among gynecologist-collected samples. However, 9.3% of the patients were HPV HC II-positive in the seff-collected sample and HPV HC II-negative in the gynecologist-collected samples (95% CI: 7.38%-11.22%), whereas 4% tested positive in gynecologist-collected samples and negative in self-collected samples (95% CI: 2.7%-5.3%) (P < 0.01; kappa=0.7). Of 9 cases of histologically-confirmed, high-grade squamous intraepithelial lesion, self-collected and provider-collected samples missed one each. Conclusion: Self-collected vaginal. sampling could be made an additional CHA function under existing program conditions, improving access to cervical cancer screening in poor rural settings. (c) 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.