Cervical cancer screening: Thumbs up for HPV self-sampling among women in SG

Human papillomavirus (HPV) self-sampling for cervical cancer screening is highly acceptable among Singaporean women, with the strategy deemed accurate and easy to perform, a study has found.

In a cohort of 300 women who underwent both HPV self-sampling and physician-sampling, the majority reported that the former was not difficult to do (79 percent) and caused only minimal discomfort (89 percent). [Ann Acad Med Singap 2022;51:733-735]

The women also expressed a strong preference for self-sampling over physician-sampling (84 percent vs 13 percent), and 86 percent of those who preferred self-sampling indicated that they would choose to perform this at home rather than at a clinic (14 percent).

If self-sampling became available in the future, 90 percent of the women specified that they would likely participate in cervical cancer screening, and about half (51 percent) expressed willingness to pay for the self-sampling swab.

“From our study, it was evident the acceptability of the self-sampling swab by the participants was high as the majority found it easy to perform with minimal discomfort, anxiety, and embarrassment,” the investigators said.

“Our study also showed substantial agreement between the results from the self-sampling and physician-sampling tests [kappa, 0.77, 95 percent confidence interval (CI) 0.67–0.86; p<0.001], as corroborated by international meta-analyses,” they added. [Lancet Oncol 2014;15:172-183; Gynecol Oncol 2007;105:530-535]

Twenty percent of self-collected samples and 21.0 percent of physician-collected samples tested positive for high-risk HPV. Out of 300 self-collected samples, 227 (92.3 percent) yielded results that were concordant with those of physician-collected samples. Self-sampling tests had a sensitivity of 83.3 percent (95 percent CI, 71.5–91.7) and specificity of 94.6 percent (95 percent CI, 90.9–97.1).

The women who participated in the study were aged 30–69 years, with 72.7 percent Chinese, 17.3 percent Malay, and 5.3 percent Indian; the remaining 4.7 percent belonged to other ethnic groups. None of these women were pregnant, had previous total hysterectomy, had history of cervical cancer, were currently menstruating, had never had sexual intercourse, and had recent negative cervical cancer screening.

Boosting screening participation

“Cervical cancer is known to be the most preventable malignancy through both vaccination and screening. However, it remains the 10th most common cancer among women in Singapore… [with] only one in two women undergo[ing] regular screening in Singapore,” according to the investigators. [https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-2019_annual-report_final.pdf]

“HPV self-sampling is a potential intervention that can increase cervical cancer screening uptake by overcoming barriers such as fear, discomfort, and the inconvenience of visiting a health centre for screening,” they added. [BMC Cancer 2015;15]

In fact, a clinical trial that targeted the under-screened population in the US showed that mailing HPV kits was able to improve screening uptake than did usual care reminders for in-clinic screening. This is in line with present study’s finding that women were more likely to participate in screening if the self-sampling method was available. [JAMA Netw Open 2019;2:e1914729]

Given the high efficacy and acceptability of the HPV self-sampling method, it has been integrated into national screening programmes of countries such as Australia and the Netherlands in a move to increase cervical screening uptake, the investigators said.

“Results from our study are encouraging, and this could pave the way for Singapore to incorporate self-sampling into [its own] national screening programme,” they added.

The World Health Organization cites increasing screening uptake as one of its three-pronged approaches to achieve the goal of eradicating cervical cancer globally. The investigators believe that incorporating a self-sampling test would help Singapore move closer to this goal. [Int J Gynaecol Obstet 2020;148:1-2]