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Ji X, Hao M, Wang Y, Kong W, Pan Z, Sun Q, Miao J. Human papillomavirus self-sampling in Asia: a systematic review. Front Microbiol 2025; 16:1540609. [PMID: 40160269 PMCID: PMC11949917 DOI: 10.3389/fmicb.2025.1540609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 02/27/2025] [Indexed: 04/02/2025] Open
Abstract
Background Human papillomavirus (HPV) self-sampling may be an accurate and effective alternative sampling method to conventional cervical cancer screening methods. This systematic review compares the accuracy and acceptance of self-sampling to clinician sampling for HPV testing in Asia. Methods The PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases were searched for publications published from the establishment of the database to 2023. The risk of bias was assessed using the QUADAS-2 tool for studies included in this review. All studies evaluating the accuracy and acceptance of HPV self-sampling, and agreement of self- and clinician-collected samples in Asia were included. The accuracy of each study was demonstrated through the sensitivity and specificity in diagnosing cervical intraepithelial neoplasia or cancer, as well as the detection rate of HPV. The agreement between the two sampling methods was assessed based on the detection outcomes of HPV. Acceptance was indicated by women's preferences for HPV self-sampling. Results Sixty-seven studies including 117,279 adult, female participants were included in this review. The type of HPV screening, other intervention components, study design, sample size, follow-up period, analysis method, numerical outcomes, results, and limitations were extracted from each study. The sensitivity and specificity of HPV self-sampling in detecting cervical intraepithelial neoplasia were higher than 80% and 70%, consistent with the results of HPV clinician sampling. The consistency between self-sampling and clinician-sampling was high in most studies, and the kappa value was more than 0.7. Women had high acceptance of self-sampling but expressed some concerns. Conclusion Self-sampling for HPV testing can significantly improve cervical cancer screening coverage, especially in areas with limited medical resources or reluctance to accept physician sampling. In most studies, the accuracy and acceptance of HPV self-sampling was comparable to clinician sampling. However, the diagnostic criteria and HPV detection methods still need to be adjusted due to the low sensitivity of HPV self-sampling in some studies in China and India. Targeted health education should be carried out to improve the acceptance of HPV self-sampling in women. Systematic review registration https://inplasy.com/?s=INPLASY202520107, INPLASY202520107.
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Affiliation(s)
- Xuechao Ji
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Menglin Hao
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Yixiao Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Wenzhi Kong
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Zangyu Pan
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Qi Sun
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Jinwei Miao
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
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Otieno JA, Were L, Nyanchoka M, Olwanda E, Mulaku M, Sem X, Kohli M, Markby J, Muriuki A, Ochodo E. Human papillomavirus self-sampling versus provider-sampling in low- and middle-income countries: a scoping review of accuracy, acceptability, cost, uptake, and equity. Front Public Health 2024; 12:1439164. [PMID: 39678248 PMCID: PMC11638174 DOI: 10.3389/fpubh.2024.1439164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 11/15/2024] [Indexed: 12/17/2024] Open
Abstract
Introduction HPV self-sampling is a relatively new, cost-effective and widely accepted method, however, uptake in LMICs remains limited. We aimed to map out the evidence and identify gaps in accuracy, acceptability, cost, equity and uptake of self-sampling vs. provider-sampling in LMICs. Methods We searched: MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, and Global Index Medicus, from 1946 to July 2023. Inclusion criteria entailed studies focusing on self-sampling alone or compared to provider-sampling for HPV testing and reporting on at least one outcome of interest (accuracy, acceptability, cost, equity, or uptake). Two authors independently screened titles, abstracts, and full texts, resolving disagreements through discussion. Data was extracted by one reviewer independently, with quality checks by senior authors, and results were synthesised narratively. Results Our search yielded 3,739 records, with 124 studies conducted on 164,165 women aged 15-88 years between 2000 and 2023 included. Most studies were from the African region (n = 61, 49.2%). Designs included cross-sectional (n = 90, 81.1%), randomised (n = 5, 4.5%), modelling (n = 4, 3.6%), micro-costing (n = 2, 1.8%), and non-randomised crossover (n = 1, 0.9%) studies. Outcomes included; acceptability (n = 79, 63.7%), accuracy (n = 51, 41.1%), cost (n = 7, 5.6%), and uptake (n = 7, 5.6%). Most studies reported that participants preferred self-sampling, with only a few studies (n = 7, 8.9%) studies favouring provider-sampling. The sensitivity and specificity of self-sampling ranged from 37.5-96.8% and 41.6-100.0%, respectively. One study directly compared the sensitivity and specificity of dry self-collected vs. wet provider-collected sample transportation. Laboratory costs were similar, but overall costs were lower for self-sampling. Uptake was higher for self-sampling in five of the seven studies. Most studies (n = 106) mentioned equity factors like age (n = 69, 65.1%), education (n = 68, 64.2%) and place of residence (n = 59, 55.6%) but no analysis of their impact was provided. Conclusion HPV self-sampling is acceptable and cost-effective but, evidence of its accuracy shows varying sensitivity and specificity. Evidence on the accuracy of dry self-collected vs. wet provider-collected sample transportation is limited. Research evaluating HPV self-sampling's accuracy, including comparisons of transportation modes, uptake, the impact of equity factors in LMICs and comparisons with high-income countries is essential to inform cervical cancer screening uptake. Systematic review registration https://doi.org/10.17605/OSF.IO/34TUY.
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Affiliation(s)
- Jenifer Akoth Otieno
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Lisa Were
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Moriasi Nyanchoka
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Easter Olwanda
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mercy Mulaku
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Department of Pharmacology, Clinical Pharmacy, and Pharmacy Practice, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | | | | | | | - Eleanor Ochodo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
- Center for Evidence-Based Health Care, Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Phoolcharoen N, Areeruk W, Kantathavorn N, Tiyayon J, Chittithaworn S, Wetcho T, Satitniramai S, Khomphaiboonkij U, Pitakkarnkul S, Termrungruanglert W, Srisomboon J, Tangjitgamol S, Research Group TGCS. Self- and physician-collected high-risk human papillomavirus (HPV) testing to detect high-grade cervical lesions among Thai women. Int J Gynecol Cancer 2023; 33:1354-1358. [PMID: 37612037 DOI: 10.1136/ijgc-2023-004424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE We compared the performance of high-risk human papillomavirus (HPV) messenger RNA testing of physician- and self-collected specimens for detecting histological grade 2 or higher cervical intraepithelial neoplasia (CIN) among women who visited a colposcopy clinic in Thailand. METHODS From January 2022 to April 2022, 500 women participated in this cross-sectional multicenter study; 494 had complete data and valid specimen results. The participants were women who attended any one of the 10 participating institutes' colposcopy clinics due to abnormal cytology, positive high-risk HPV testing, or for follow-up. Participants used a self-sampling Aptima Multitest Swab specimen collection kit to self-collect vaginal samples before physicians biopsied the cervix during the colposcopic examination. The self- and physician-collected specimens were tested for high-risk HPV messenger RNA using Aptima nucleic acid amplification assays. Cervical tissues were collected during colposcopic-directed biopsy from the most severe lesion or a random biopsy and endocervical curettage specimen if no lesion was detected. RESULTS We detected high-risk HPV messenger RNA in 75.4% of self-collected specimens and 70.6% of physician-collected specimens. The prevalence of histological grade 2 or higher CIN from cervical histology was 25.1% (n=124). For self-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 87.0% (95% CI 79.7% to 92.4%; n=108) and 28.5% (95% CI 24.0% to 33.4%). For physician-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 90.2% (95% CI 83.6% to 94.9%; n=112) and 36.1% (95% CI 31.2% to 41.3%). CONCLUSIONS Self-collected specimens for high-risk HPV messenger RNA testing demonstrated good sensitivity and negative predictive value for detecting grade 2 or higher CIN in Thai women attending the participating institutes' colposcopy clinics. Self-collected samples performed similarly to physician-collected ones.
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Affiliation(s)
- Natacha Phoolcharoen
- Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wilasinee Areeruk
- Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nuttavut Kantathavorn
- Princess Srisavangavadhana College of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jitima Tiyayon
- Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
| | - Suwicha Chittithaworn
- Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanita Wetcho
- Princess Srisavangavadhana College of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Sikarn Satitniramai
- Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Wichai Termrungruanglert
- Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Siriwan Tangjitgamol
- Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Dau H, Vidler M, AboMoslim M, Mutamba B, Nesbitt Z, Deodatha J, Byiringiro SD, Niyotwiringiye C, Mithani N, Nair V, Smith L, Rulisa S, Ogilvie G. The barriers to cervical cancer screening for urban and rural populations in Rwanda. BMC GLOBAL AND PUBLIC HEALTH 2023; 1:4. [PMID: 39681867 DOI: 10.1186/s44263-023-00005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/12/2023] [Indexed: 12/18/2024]
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer mortality in Rwandan women. There is a limited understanding of the barriers that women face to obtain cervical cancer screening in Rwanda. It is important to understand the barriers in order to implement effective screening programs. The goal of this study is to describe the barriers to cervical cancer screening among women in Rwanda and how they differ among women in rural and urban areas. METHODS This cross-sectional study recruited women from June 1 to 9, 2022, at Muhima and Nyamata District Hospitals in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. Women completed a 15-min survey which included questions on the participants' demographics, knowledge of cervical cancer, cervical cancer screening history, and barriers to healthcare. Women were stratified by survey location (urban vs rural). Descriptive statistics were reported. RESULTS A total of 374 women completed the survey with 169 participants from Muhima and 205 from Nyamata. Most women were in a relationship and had a primary school or less education. The most common barriers to accessing general healthcare services were long wait times at the facility (Muhima 26%; Nyamata 30%), low quality of care (Muhima 15%; Nyamata 12%), and transportation costs (Muhima 13%; Nyamata 9.3%). However, women from Nyamata were significantly more likely to report distance to the health center as a barrier (p-value < 0.001), and women from Muhima were significantly more likely to report transportation method as a barrier (p-value = 0.004). The primary reason reported for not obtaining cervical cancer screening was that women did not know how or where to get tested (Muhima 57%; Nyamata 51%). CONCLUSIONS The most common barriers to cervical cancer screening in Rwanda were the quality of clinical care and issues with traveling to the clinic. Implementing a cervical cancer self-collection program could help eliminate many barriers that women face to obtain health services in Rwanda. More research is needed to better understand the acceptability of cervical cancer screening in Rwanda and how it could be integrated into the healthcare system.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Maryam AboMoslim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
| | | | - Zoey Nesbitt
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Nadia Mithani
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Varun Nair
- Women's Health Research Institute, Vancouver, BC, Canada
- Integrated Sciences, University of British Columbia Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, BC, Canada
- BC Cancer, Vancouver, Canada
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Women's Health Research Institute, Vancouver, BC, Canada.
- BC Centre for Disease Control, Vancouver, Canada.
- BC Women's Hospital and Health Centre, Box 42, Room H203G - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
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Creagh NS, Boyd LAP, Bavor C, Zammit C, Saunders T, Oommen AM, Rankin NM, Brotherton JML, Nightingale CE. Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence. JCO Glob Oncol 2023; 9:e2200297. [PMID: 36724416 PMCID: PMC10166429 DOI: 10.1200/go.22.00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Although cervical cancer is a disease of inequity, it can be eliminated as a public health problem through vaccination, screening, and treatment. Human papillomavirus vaginal self-collection cervical screening is a high-performance test that can increase reach of screening. This review describes the different contexts and models of care used to pilot or implement self-collection within the Asia-Pacific, measures the extent that implementation outcome measures are reported and, where available, summarizes key implementation findings. METHODS A scoping review was conducted by searching five databases of the peer-reviewed literature on June 20, 2022. Two researchers assessed eligibility and extracted data independently to the model of care used and the Conceptual Framework for Implementation Outcomes. A mixed-method consolidation of findings (quantitative: count and frequencies; qualitative: content analysis) was undertaken to narratively report findings. RESULTS Fifty-seven articles, comprising 50 unique studies from 11 countries and two special autonomous regions, were included; 82% were conducted in trials. The implementation of self-collection was conducted in low- (2%), lower-middle- (32%), upper-middle- (32%), and high-income (35%) settings, with 10 different delivery models used; 80% delivered through practitioner-supported models with diversity in how samples were processed, and treatment was offered. Acceptability (73%) and appropriateness (64%) measures were most reported, followed by adoption (57%), feasibility (48%), and fidelity (38%). Only 7% of articles reported implementation cost or penetration measures. No articles reported sustainability measures. CONCLUSION The literature confirms that self-collection cervical screening has been implemented within the Asia-Pacific region, with evidence demonstrating that it is acceptable and appropriate from the user's perspective. Well-designed, high-quality implementation trials and real-world evaluations of self-collection that report the breadth of implementation outcomes can support the progression toward the elimination of cervical cancer.
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Affiliation(s)
- Nicola Stephanie Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy Ann Patricia Boyd
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Bavor
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Zammit
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tessa Saunders
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anu Mary Oommen
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Community Health Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nicole Marion Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Mary Louise Brotherton
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
| | - Claire Elizabeth Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Di Gennaro G, Licata F, Trovato A, Bianco A. Does self-sampling for human papilloma virus testing have the potential to increase cervical cancer screening? An updated meta-analysis of observational studies and randomized clinical trials. Front Public Health 2022; 10:1003461. [PMID: 36568753 PMCID: PMC9773849 DOI: 10.3389/fpubh.2022.1003461] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives A meta-analysis was conducted to examine the effectiveness of HPV self-sampling proposal on cervical cancer screening (CCS) uptake when compared with an invitation to have a clinician to collect the sample. Secondary outcomes were acceptability and preference of self-sampling compared to clinician-collected samples. Methods The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining the CCS uptake comparing self-sampling over invitation to be sampled by an healthcare professional and examining the proportion of women accepting or preferring self-sampling vs. clinician-collected sampling were included. The CCS uptake was also explored according to strategy of self-samplers' distribution, collection device type and screening status. Peters' test and Funnel Plot inspection were used to assess the publication bias. Quality of the studies was assessed through Cochrane Risk of Bias and NIH Quality Assessment tools. Results One hundred fifty-four studies were globally identified, and 482,271 women were involved. Self-sampling procedures nearly doubled the probability (RR: 1.8; 95% CI: 1.7-2.0) of CCS uptake when compared with clinician-collected samples. The opt-out (RR: 2.1; 95% CI: 1.9-2.4) and the door-to-door (RR: 1.8; 95% CI: 1.6-2.0) did not statistically significant differ (p = 1.177) in improving the CCS uptake. A higher relative uptake was shown for brushes (RR: 1.6; 95% CI: 1.5-1.7) and swabs (RR: 2.5; 95% CI: 1.9-3.1) over clinician-collected samples. A high between-studies variability in characteristics of sampled women was shown. In all meta-analyses the level of heterogeneity was consistently high (I 2 > 95%). Publication bias was unlikely. Conclusions Self-sampling has the potential to increase participation of under-screened women in the CCS, in addition to the standard invitation to have a clinician to collect the sample. For small communities door-to-door distribution could be preferred to distribute the self-sampler while; for large communities opt-out strategies should be preferred over opt-in. Since no significant difference in acceptability and preference of device type was demonstrated among women, and swabs and brushes exhibited a potential stronger effect in improving CCS, these devices could be adopted.
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Affiliation(s)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
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Bohn JA, Fitch KC, Currier JJ, Bruegl A. HPV self-collection: what are we waiting for? Exploration of attitudes from frontline healthcare providers. Int J Gynecol Cancer 2022; 32:1519-1523. [PMID: 36351745 DOI: 10.1136/ijgc-2022-003860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Polymerase chain reaction based human papilloma virus (HPV) self-collection for cervical cancer screening is well established. It is utilized worldwide, accepted by patients, is cost-effective, has comparable sensitivity to provider-collected samples, and increases screening rates, however clinical practice in the United States has not shifted to include HPV self-collection. This study sought to examine provider knowledge and attitudes to better understand why HPV self-collection is not being utilized. METHODS An observational, qualitative study was conducted. Data were collected with semi-structured focus groups and individual interviews with Oregon healthcare providers. Focus groups and interviews were continued until data saturation was achieved. A grounded theory method was used for analysis, a cyclical process of coding data, memo-writing, and theoretical sampling to the point of saturation. RESULTS Eighteen healthcare providers participated in the focus group and interviews. They represented 14 of 36 counties across Oregon and 50% were physicians, 33% were nurse practitioners, and 94% worked within family medicine. All providers performed cervical cancer screening according to current American Society for Colposcopy and Cervical Pathology guidelines. Five overarching themes emerged: provider concerns, clinical and provider barriers, patient perspective and barriers, process-based themes, and barriers to cervical cancer screening. Nearly all providers stated they will offer HPV self-collection to most of their patients once available. CONCLUSION While providers identified concerns and barriers for initiating HPV self-collection, there was a strong desire to implement HPV self-collection and acceptance within patient populations was assumed. Providers indicated the need for HPV self-collection to be incorporated into national screening guidelines along with best practices on how to successfully implement this modality to further increase cervical cancer screening rates.
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Affiliation(s)
- Jacqueline A Bohn
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Katherine C Fitch
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Jessica J Currier
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, Oregon Health & Sciences University, Portland, Oregon, USA
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Adewumi K, Nishimura H, Oketch SY, Adsul P, Huchko M. Barriers and Facilitators to Cervical Cancer Screening in Western Kenya: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1122-1128. [PMID: 33411253 PMCID: PMC9257902 DOI: 10.1007/s13187-020-01928-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
About nine out of 10 cervical cancer deaths occur in low-resource countries, with a particularly high burden in sub-Saharan Africa. The objectives of this study were to assess barriers and facilitators to cervical cancer screening in western Kenya from the perspectives of community members and healthcare providers. We conducted two focus groups with female community members (n = 24) and one with providers (n = 12) in Migori County, Kenya. Discussion guides queried about knowledge and awareness of cervical cancer prevention; structural, social, and personal barriers; and facilitators towards cervical cancer screening uptake. Group discussions were recorded, transcribed, and analyzed for emerging themes. Participants in both groups reported low awareness of HPV and cervical cancer screening in the community, and identified that as a main barrier to screening. Community members reported fear of pain and embarrassment as significant barriers to a screening pelvic exam. They also reported that providers' lack of knowledge and discomfort with a sensitive subject were significant barriers. A personal connection to cervical cancer and/or screening was associated with willingness to screen and awareness. Providers reported workload and lack of supplies and trained staff as significant barriers to offering services. Based on these findings, we identified three intervention components to address these facilitators and barriers to screening. They include utilizing existing social networks to expand awareness of cervical cancer risk and screening, training non-physician health workers to meet the demand for screening, and employing female-driven screening techniques such as self-collection of specimens for HPV testing. Cervical cancer prevention programs must take into account the local realities in which they occur. In low-resource areas in particular, identifying low-cost, effective, and culturally appropriate strategies for addressing poor screening uptake is important given limited funding. This study took a formative approach to identify facilitators and barriers to cervical cancer screening based on focus groups and interviews with community members and healthcare providers.
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Affiliation(s)
- Konyin Adewumi
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Holly Nishimura
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Sandra Y Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Prajakta Adsul
- National Cancer Institute/National Institutes of Health, Bethesda, MD, USA
| | - Megan Huchko
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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Effects of Menstrual Cycle on the Accumulation of Human Papillomavirus-Infected Cells Exfoliated from the Cervix That Drift into the Vagina. Microorganisms 2022; 10:microorganisms10040693. [PMID: 35456745 PMCID: PMC9029653 DOI: 10.3390/microorganisms10040693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Human papillomavirus (HPV) testing using self-collected vaginal specimens is the preferred choice to increase screening uptake. Although the HPV testing results of these samples depend on the cells that naturally exfoliate from the cervical lesion and drift into the vagina, the mechanism of when and how these exfoliated cells mix with the self-collected sample remains unclear. Hence, the study aimed to clarify the relationship between the vaginal drift of HPV-infected cells exfoliated from the cervix, and the menstrual cycle. A total of 180 scraped samples of the cervix and vagina were examined. The exfoliated cells were classified into two categories according to the HPV genotyping results of each sample: sufficient accumulation (same HPV types in cervical and vaginal samples) and insufficient accumulation (fewer HPV types in vaginal samples than in cervical samples, or HPV positivity in cervical samples and HPV negativity in vaginal samples). A moderately strong statistically significant association was observed between exfoliated cell accumulation and the menstrual cycle, and insufficient accumulation was statistically significantly increased at the early proliferative phases. Self-collection of vaginal samples at the early proliferation phase indicates insufficient sample quantities or lower viral load, thereby affecting HPV genotyping.
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Sormani J, Kenfack B, Wisniak A, Moukam Datchoua A, Lemoupa Makajio S, Schmidt NC, Vassilakos P, Petignat P. Exploring Factors Associated with Patients Who Prefer Clinician-Sampling to HPV Self-Sampling: A Study Conducted in a Low-Resource Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:54. [PMID: 35010314 PMCID: PMC8744711 DOI: 10.3390/ijerph19010054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 05/22/2023]
Abstract
Human papillomavirus (HPV) self-sampling (Self-HPV) is a promising strategy to improve cervical cancer screening coverage in low-income countries. However, issues associated with women who prefer conventional HPV clinical-sampling over HPV self-sampling may affect screening participation. To address this issue, our study assessed factors associated with women's preferences related to Self-HPV. This study was embedded in a large clinical trial recruiting women aged 30-49 years in a primary HPV-based study termed "3T-Approach" (for Test-Triage-Treatment), launched in 2018 at Dschang District Hospital, West Cameroon. Participants were invited to perform a Self-HPV. After the sampling and before receiving the results, participants completed a questionnaire about cervical cancer screening and their preferences and perceptions around Self-HPV. The median age of the 2201 participants was 40.6 (IQR 35-45) years. Most (1693 (76.9%)) preferred HPV self-sampling or had no preference for either method, and 508 (23.1%) preferred clinician-sampling. Factors associated with an increased likelihood of reporting a clinician-sampling preference were tertiary educational level (29.4% CI: 25.6-33.6 vs. 14.4% CI: 12.8-16.1) and being an employee with higher grade professional or managerial occupations (5.5% CI: 3.8-7.9 vs. 2.7% CI: 2.0-3.5). The main reported reason for women preferring clinician-sampling was a lack of "self-expertise". Most women (>99%) would agree to repeat HPV self-sampling and would recommend it to their relatives. HPV self-sampling in the cultural context of central Africa was well accepted by participants, but some participants would prefer to undergo clinician sampling. Health systems should support well-educated women to increase self-confidence in using HPV self-sampling.
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Affiliation(s)
- Jessica Sormani
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, 1205 Geneva, Switzerland; (A.W.); (S.L.M.); (N.C.S.); (P.V.); (P.P.)
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1227 Geneva, Switzerland
| | - Bruno Kenfack
- Department of Obstetrics and Gynecology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon;
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon;
| | - Ania Wisniak
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, 1205 Geneva, Switzerland; (A.W.); (S.L.M.); (N.C.S.); (P.V.); (P.P.)
| | - Alida Moukam Datchoua
- Department of Gynaecology and Obstetrics, District Hospital of Dschang, Dschang, Cameroon;
| | - Sophie Lemoupa Makajio
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, 1205 Geneva, Switzerland; (A.W.); (S.L.M.); (N.C.S.); (P.V.); (P.P.)
- Faculty of Medicine, Institute of Global Health, University of Geneva, 1205 Geneva, Switzerland
| | - Nicole C. Schmidt
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, 1205 Geneva, Switzerland; (A.W.); (S.L.M.); (N.C.S.); (P.V.); (P.P.)
- Faculty of Social Science, Catholic University of Applied Science, 55122 Mainz, Germany
| | - Pierre Vassilakos
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, 1205 Geneva, Switzerland; (A.W.); (S.L.M.); (N.C.S.); (P.V.); (P.P.)
- Geneva Foundation for Medical Education and Research, 1202 Geneva, Switzerland
| | - Patrick Petignat
- Gynaecology Division, Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, 1205 Geneva, Switzerland; (A.W.); (S.L.M.); (N.C.S.); (P.V.); (P.P.)
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Patient Satisfaction With Human Papillomavirus Self-Sampling in a Cohort of Ethnically Diverse and Rural Women in Yunnan Province, China. J Low Genit Tract Dis 2021; 24:349-352. [PMID: 32796262 PMCID: PMC7515469 DOI: 10.1097/lgt.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rural Yunnan Province is one of the most ethnically, culturally, and religiously diverse regions in China. The majority of its women have never been screened for cervical cancer. It is not known whether women would feel comfortable and ultimately even prefer using a human papillomavirus (HPV) self-swabbing method.
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12
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Nishimura H, Yeh PT, Oguntade H, Kennedy CE, Narasimhan M. HPV self-sampling for cervical cancer screening: a systematic review of values and preferences. BMJ Glob Health 2021; 6:e003743. [PMID: 34011537 PMCID: PMC8137189 DOI: 10.1136/bmjgh-2020-003743] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The WHO recommends human papillomavirus (HPV) cervical self-sampling as an additional screening method and HPV DNA testing as an effective approach for the early detection of cervical cancer for women aged ≥30 years. This systematic review assesses end user's values and preferences related to HPV self-sampling. METHODS We searched four electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature and Embase) using search terms for HPV and self-sampling to identify articles meeting inclusion criteria. A standardised data extraction form was used to capture study setting, population, sample size and results related to values and preferences. RESULTS Of 1858 records retrieved, 72 studies among 52 114 participants published between 2002 and 2018 were included in this review. Almost all studies were cross-sectional surveys. Study populations included end users who were mainly adolescent girls and adult women. Ages ranged from 14 to 80 years. Most studies (57%) were conducted in high-income countries. Women generally found HPV self-sampling highly acceptable regardless of age, income or country of residence. Lack of self-confidence with collecting a reliable sample was the most commonly cited reason for preferring clinician-collected samples. Most women preferred home-based self-sampling to self-sampling at a clinic. The cervical swab was the most common and most accepted HPV DNA sampling device. CONCLUSIONS HPV self-sampling is generally a highly accepted method of cervical cancer screening for end users globally. End user preferences for self-sampling device, method and setting can inform the development of new and expanded interventions to increase HPV screening.
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Affiliation(s)
- Holly Nishimura
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Habibat Oguntade
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
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13
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Kamath Mulki A, Withers M. Human Papilloma Virus self-sampling performance in low- and middle-income countries. BMC WOMENS HEALTH 2021; 21:12. [PMID: 33407355 PMCID: PMC7789658 DOI: 10.1186/s12905-020-01158-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
Background Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. Methods This study’s objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs.
Results Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86–97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants’ homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75–97%, 18 studies), painless (60–90%, nine studies), and preferred over provider-collected sampling (57–100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. Conclusion Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.
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Affiliation(s)
- Ashwini Kamath Mulki
- Department of Family Medicine, Lehigh Valley Health Network, 1730 Chew St, Allentown, PA, 18104, USA. .,Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA.
| | - Mellissa Withers
- Keck School of Medicine, University of Southern California, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90032, USA
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14
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Letter to the Editor. J Low Genit Tract Dis 2020; 24:423. [PMID: 32986388 DOI: 10.1097/lgt.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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For Human Papillomavirus Self-Sampling, Stated Willingness Does Not Correspond With Subsequent Uptake by Rural Malawian Women. Sex Transm Dis 2020; 47:275-279. [PMID: 32168286 PMCID: PMC9808893 DOI: 10.1097/olq.0000000000001119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Human papilloma virus (HPV), the causative agent for cervical cancer, can be tested for using self-collected vaginal samples. Self-collection is promising for HPV screening in hard-to-reach populations. To assess the relationship between willingness to self-collect and subsequent uptake of self-collection, we conducted a longitudinal study of reproductive-age women in rural Malawi. METHODS At baseline, we asked women if they would be willing to self-collect a vaginal sample for HPV testing. At follow-up (12-18 months later), we offered the same women the opportunity to self-collect a sample for HPV testing. We examined unadjusted and adjusted associations between baseline willingness to self-collect a sample for HPV testing and uptake of self-collection at follow-up using log-binomial models. RESULTS Among 122 women who, at baseline, indicated willingness to self-collect, n = 65 (53%) agreed to self-collect a sample at follow-up. Of 64 women who stated unwillingness at baseline to self-collect, n = 30 (47%) self-collected a sample for testing at follow-up. We observed no association between women's willingness at baseline and their observed self-collection decision at follow-up (unadjusted prevalence ratio, 1.14; 95% confidence interval, 0.83-1.55). The association remained null after adjustment for age, awareness of cervical cancer, and perceived behavioral control. CONCLUSIONS Our results suggest that evaluation of acceptability of self-collection should go beyond simply asking women if they would be willing to self-collect a vaginal sample. Given that half of this study's participants agreed to self-collect a sample when the opportunity was offered, regardless of their previously stated preferences, self-collection should be offered to everyone.
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16
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Chai Z, Yang Y, Gu Z, Cai X, Ye W, Kong L, Qiu X, Ying L, Wang Z, Wang L. Recombinant Viral Capsid Protein L2 (rVL2) of HPV 16 Suppresses Cell Proliferation and Glucose Metabolism via ITGB7/C/EBPβ Signaling Pathway in Cervical Cancer Cell Lines. Onco Targets Ther 2019; 12:10415-10425. [PMID: 31819523 PMCID: PMC6890187 DOI: 10.2147/ott.s228631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose Capsid protein L2 is the minor capsid protein of human papillomavirus 16 (HPV16). Although L2-based vaccines were developed, the therapeutic effect of recombinant viral capsid protein L2 (rVL2) was still to be illustrated. Methods We used glucose uptake and lactate production assay to verify the inhibitory effect of rVL2 on the glucose metabolism in cervical cancer cells. Secondly, we performed gene-chip assay, RT-PCR, and Western blot to determine the role of ITGB7/C/EBPβ signaling pathway in rVL2-mediated glucose metabolism in vitro. Finally, we used an animal model to verify the function of rVL2 in cervical cancer. Results We found that rVL2 reduced glucose uptake and lactate production levels in cervical cancer cells, which caused the inhibition of cell proliferation. rVL2 decreased the expression levels of key metabolic enzymes, including GLUT1, LDHA, and ALDOA, to affect cell metabolism in cervical cancer cells by inhibiting ITGB7/C/EBPβ signaling pathway in vitro and in vivo. Conclusion These results demonstrated the vital role of rVL2 in the glycolysis-induced cell growth and proliferation via suppressing ITGB7/C/EBPβ signaling axis.
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Affiliation(s)
- Zhihong Chai
- Department of Gynecology and Department of Radiology, Taizhou Municipal Hospital Affiliated to Taizhou University School of Medicine, Taizhou 318000, People's Republic of China
| | - Yufei Yang
- Department of Obstetrics and Gynecology, Xihua Hospital Affiliated to Shanghai Jiaotong University School Medicine, Shanghai 200092, People's Republic of China.,Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - ZhongYi Gu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai 201102, People's Republic of China
| | - Xianli Cai
- Department of Gynecology and Department of Radiology, Taizhou Municipal Hospital Affiliated to Taizhou University School of Medicine, Taizhou 318000, People's Republic of China
| | - Wenwei Ye
- Department of Gynecology and Department of Radiology, Taizhou Municipal Hospital Affiliated to Taizhou University School of Medicine, Taizhou 318000, People's Republic of China
| | - Lin Kong
- Department of Gynecology and Department of Radiology, Taizhou Municipal Hospital Affiliated to Taizhou University School of Medicine, Taizhou 318000, People's Republic of China
| | - Xiaoxiao Qiu
- Department of Gynecology and Department of Radiology, Taizhou Municipal Hospital Affiliated to Taizhou University School of Medicine, Taizhou 318000, People's Republic of China
| | - Lingxiao Ying
- Department of Gynecology and Department of Radiology, Taizhou Municipal Hospital Affiliated to Taizhou University School of Medicine, Taizhou 318000, People's Republic of China
| | - Ziliang Wang
- Department of Obstetrics and Gynecology, Xihua Hospital Affiliated to Shanghai Jiaotong University School Medicine, Shanghai 200092, People's Republic of China.,Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Linyou Wang
- Department of Gynecology and Department of Radiology, Taizhou Municipal Hospital Affiliated to Taizhou University School of Medicine, Taizhou 318000, People's Republic of China
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Acceptability of Women Self-Sampling versus Clinician-Collected Samples for HPV DNA Testing: A Systematic Review. J Low Genit Tract Dis 2019; 23:193-199. [PMID: 30933030 DOI: 10.1097/lgt.0000000000000476] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Female self-sampling for human papillomavirus (HPV) DNA testing is an alternative screening method that can potentially increase cervical cancer screening coverage. This review addresses the acceptability of HPV DNA testing using self-sampling compared with conventional clinician-collected sampling. Barriers to and others factors associated with acceptability of either method were also examined. METHODS The following electronic resources were searched: Medline @EBSCOHOST(Medline), Embase, PubMed, and CINAHL databases. Manual searches were also conducted. The main outcome of interest was the acceptability of HPV DNA testing by self-sampling in comparison with clinician-collected sampling. RESULTS In total, 23 articles were included in this systematic review. The majority (19 studies) were quantitative intervention studies and 4 studies were qualitative observational studies. Eleven studies reported a preference for self-sampling by women compared with clinician-collected sampling (64.7%-93%). The remaining studies found that women preferred clinician-collected sampling because mainly of respondents' lack of confidence in their ability to complete self-sampling correctly. In most articles reviewed, the studied associated factors, such as demographic factors (age, marital status, and ethnicity), socioeconomic factors (income, education level), reproductive factors (condom use, number of children, current use of contraception, and number of partners), and habits (smoking status) were not found to be significantly associated with preference. CONCLUSIONS Both methods of sampling were found to be acceptable to women. Self-sampling is cost-effective and could increase the screening coverage among underscreened populations. However, more information about the quality, reliability, and accuracy of self-sampling is needed to increase women's confidence about using to this method.
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18
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Phoolcharoen N, Kantathavorn N, Krisorakun W, Taepisitpong C, Krongthong W, Saeloo S. Acceptability of Self-Sample Human Papillomavirus Testing Among Thai Women Visiting a Colposcopy Clinic. J Community Health 2019; 43:611-615. [PMID: 29302852 DOI: 10.1007/s10900-017-0460-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We offered self-sampling devices to 250 women who visited the colposcopy clinic at Chulabhorn Hospital, Bangkok, Thailand from March 1 to June 30, 2015. Participants received instruction about the vaginal self-sample method and collected the specimen themselves, before being examined by the physician who obtained a conventional cervical specimen. Participating women's attitudes and feelings regarding the self-sample method were explored using a short questionnaire. Of the 247 eligible women, more than 90% of participants rated the self-sample method as very good to excellent for convenience, comfort, and safety. In addition, 80% of participants reported the overall experience of using the self-sample device was very good to excellent compared with the physician-collected method. Self-sample HPV testing appears to be highly accepted and perceived as convenient, comfortable, and safe. More studies on self-sample HPV testing should be conducted in Thailand to investigate this as an alternative method of cervical cancer screening, particularly among women who do not attend the screening program.
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Affiliation(s)
- Natacha Phoolcharoen
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
| | - Nuttavut Kantathavorn
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wasanai Krisorakun
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chantanee Taepisitpong
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Waraphorn Krongthong
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Siriporn Saeloo
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Breiner B, Preuss L, Roos N, Conrady M, Lilie H, Iftner T, Simon C. Refolding and in vitro characterization of human papillomavirus 16 minor capsid protein L2. Biol Chem 2019; 400:513-522. [PMID: 30375341 DOI: 10.1515/hsz-2018-0311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/25/2018] [Indexed: 01/31/2023]
Abstract
The minor capsid protein L2 of papillomaviruses exhibits multiple functions during viral entry including membrane interaction. Information on the protein is scarce, because of its high tendency of aggregation. We determined suitable conditions to produce a functional human papillomavirus (HPV) 16 L2 protein and thereby provide the opportunity for extensive in vitro analysis with respect to structural and biochemical information on L2 proteins and mechanistic details in viral entry. We produced the L2 protein of high-risk HPV 16 in Escherichia coli as inclusion bodies and purified the protein under denaturing conditions. A successive buffer screen resulted in suitable conditions for the biophysical characterization of 16L2. Analytical ultracentrifugation of the refolded protein showed a homogenous monomeric species. Furthermore, refolded 16L2 shows secondary structure elements. The N-terminal region including the proposed transmembrane region of 16L2 shows alpha-helical characteristics. However, overall 16L2 appears largely unstructured. Refolded 16L2 is capable of binding to DNA indicating that the putative DNA-binding regions are accessible in refolded 16L2. Further the refolded protein interacts with liposomal membranes presumably via the proposed transmembrane region at neutral pH without structural changes. This indicates that 16L2 can initially interact with membranes via pre-existing structural features.
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Affiliation(s)
- Bastian Breiner
- Institute of Medical Virology, University of Tübingen, Elfriede-Aulhorn-Str. 06, D-72076 Tuebingen, Germany
| | - Laura Preuss
- Institute of Medical Virology, University of Tübingen, Elfriede-Aulhorn-Str. 06, D-72076 Tuebingen, Germany
| | - Nora Roos
- Institute of Medical Virology, University of Tübingen, Elfriede-Aulhorn-Str. 06, D-72076 Tuebingen, Germany
| | - Marcel Conrady
- Institute of Medical Virology, University of Tübingen, Elfriede-Aulhorn-Str. 06, D-72076 Tuebingen, Germany
| | - Hauke Lilie
- Institute of Biochemistry and Biotechnology, Martin Luther University Halle-Wittenberg, Kurt-Mothes-Str. 03, D-06120, Halle/Saale, Germany
| | - Thomas Iftner
- Institute of Medical Virology, University of Tübingen, Elfriede-Aulhorn-Str. 06, D-72076 Tuebingen, Germany
| | - Claudia Simon
- Institute of Medical Virology, University of Tübingen, Elfriede-Aulhorn-Str. 06, D-72076 Tuebingen, Germany
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20
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Randomised study shows that repeated self-sampling and HPV test has more than two-fold higher detection rate of women with CIN2+ histology than Pap smear cytology. Br J Cancer 2018; 118:896-904. [PMID: 29438367 PMCID: PMC5886121 DOI: 10.1038/bjc.2017.485] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/08/2022] Open
Abstract
This corrects the article DOI: 10.1038/bjc.2017.85.
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21
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Assessing Acceptability of Self-Sampling Kits, Prevalence, and Risk Factors for Human Papillomavirus Infection in American Indian Women. J Community Health 2018; 41:1049-61. [PMID: 27048284 DOI: 10.1007/s10900-016-0189-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We evaluated the feasibility and acceptability of self-sampling for human papillomavirus (HPV) testing and calculated the prevalence of and risk factors for high-risk (hr) HPV infections in a community-based sample of American Indian women. To this end, we recruited 329 Hopi women aged 21-65 years to self-collect vaginal samples for hrHPV testing. Samples were tested by polymerase chain reaction for 14 hrHPV genotypes. We used Chi square tests to identify correlates of preference for clinician Pap testing versus HPV self-sampling, and age-adjusted Poisson regression to evaluate correlates of hrHPV prevalence. We found that satisfaction with HPV self-sampling was high, with 96 % of women reporting that the sample was easy to collect and 87 % reporting no discomfort. The majority (62 %) indicated that they preferred HPV self-sampling to receiving a Pap test from a clinician. Preference for Pap testing over HPV self-sampling was positively associated with adherence to Pap screening and employment outside the home. All samples evaluated were satisfactory for HPV testing, and 22 % were positive for hrHPV. HrHPV prevalence peaked in the late 20 s and declined with increasing age. HrHPV positivity was inversely associated with having children living the household. In conclusion, HPV self-sampling is feasible and acceptable to Hopi women, and could be effective in increasing rates of cervical cancer screening in Hopi communities. HrHPV prevalence was similar to estimates in the general United States population.
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22
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Van Ostade X, Dom M, Tjalma W, Van Raemdonck G. Candidate biomarkers in the cervical vaginal fluid for the (self-)diagnosis of cervical precancer. Arch Gynecol Obstet 2017; 297:295-311. [PMID: 29143101 PMCID: PMC5778162 DOI: 10.1007/s00404-017-4587-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
Purpose Despite improvement in vaccines against human papilloma virus (HPV), the causative agent of cervical cancer, screening women for cervical precancer will remain indispensable in the coming 30–40 years. A simple test that could be performed at home or at a doctor’s practice and that informs the woman whether she is at risk would significantly help make a broader group of patients who aware that they need medical treatment. Cervical vaginal fluid (CVF) is a body fluid that is very well suited for such a test. Methods Narrative review of cervical (pre)cancer candidate biomarkers from cervicovaginal fluid, is based on a detailed review of the literature. We will also discuss the possibilities that these biomarkers create for the development of a self-test or point-of-care test for cervical (pre)cancer. Results Several DNA, DNA methylation, miRNA, and protein biomarkers were identified in the cervical vaginal fluid; however, not all of these biomarkers are suited for development of a simple diagnostic assay. Conclusions Proteins, especially alpha-actinin-4, are most suited for development of a simple assay for cervical (pre)cancer. Accuracy of the test could further be improved by combination of several proteins or by combination with a new type of biomarker, e.g., originating from the cervicovaginal microbiome or metabolome.
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Affiliation(s)
- Xaveer Van Ostade
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium. .,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium.
| | - Martin Dom
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
| | - Wiebren Tjalma
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Geert Van Raemdonck
- Laboratory of Protein Science, Proteomics and Epigenetic Signaling (PPES), University of Antwerp, Wilrijk, Belgium.,Centre for Proteomics (CfP), University of Antwerp, Wilrijk, Belgium
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Dong L, Lin C, Li L, Wang M, Cui J, Feng R, Liu B, Wu Z, Lian J, Liao G, Chen W, Qiao Y. An evaluation of clinical performance of FTA cards for HPV 16/18 detection using cobas 4800 HPV Test compared to dry swab and liquid medium. J Clin Virol 2017; 94:67-71. [DOI: 10.1016/j.jcv.2017.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/25/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
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Senkomago V, Saraiya M. Examining Acceptability of Self-Collection for Human Papillomavirus Testing Among Women and Healthcare Providers with a Broader Lens. J Womens Health (Larchmt) 2017; 26:597-599. [PMID: 28414574 DOI: 10.1089/jwh.2017.6384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
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Mao C, Kulasingam SL, Whitham HK, Hawes SE, Lin J, Kiviat NB. Clinician and Patient Acceptability of Self-Collected Human Papillomavirus Testing for Cervical Cancer Screening. J Womens Health (Larchmt) 2017; 26:609-615. [PMID: 28332888 DOI: 10.1089/jwh.2016.5965] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To evaluate clinician and patient attitudes toward home self-collected human papillomavirus (HPV) testing for cervical cancer screening. METHODS Women aged 21-65 years were recruited for a randomized trial comparing home self-collected HPV testing to standard clinician-collected Pap screening. Participants were surveyed about their attitudes toward self-collected HPV testing. Clinicians performing cervical cancer screening in University of Washington medical clinics were also surveyed to determine their acceptability of self-collected HPV testing. RESULTS Over half (59.1%) of the 1,769 women surveyed preferred self-collected HPV testing to clinician-collected tests. Reasons most often cited were convenience or time saving (82.7%), and avoiding embarrassment or discomfort associated with pelvic exam (38.1%). Women who did not prefer self-collected HPV testing reported greater faith in clinician-collected samples (56.7%) or a desire for a clinic visit to address other issues (42.4%). One hundred eighteen (49.6%) of 238 physicians and midlevel providers surveyed completed the survey. The majority (78.0%) reported that they would recommend a self-collected HPV test if the test had qualities such as high sensitivity and cost effectiveness. Provider concerns mirrored those of patients, namely ensuring adequate sample collection and the opportunity to address other health concerns. CONCLUSION Patients and clinicians are supportive of self-collected HPV testing. However, concerns regarding adequacy of samples that are self collected and the desire to see a provider in a clinic setting for other health needs highlight areas that need to be addressed if self collection proves to be a viable option for cervical cancer screening.
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Affiliation(s)
- Constance Mao
- 1 Department of Obstetrics and Gynecology, University of Washington School of Medicine , Seattle, Washington
| | - Shalini L Kulasingam
- 2 Division of Epidemiology and Community Health, University of Minnesota School of Public Health , Minneapolis, Minnesota
| | - Hilary K Whitham
- 2 Division of Epidemiology and Community Health, University of Minnesota School of Public Health , Minneapolis, Minnesota
| | - Stephen E Hawes
- 3 Department of Epidemiology, University of Washington School of Medicine , Seattle, Washington
| | - John Lin
- 4 Department of Pathology, University of Washington School of Medicine , Seattle, Washington
| | - Nancy B Kiviat
- 4 Department of Pathology, University of Washington School of Medicine , Seattle, Washington
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Ma'som M, Bhoo-Pathy N, Nasir NH, Bellinson J, Subramaniam S, Ma Y, Yap SH, Goh PP, Gravitt P, Woo YL. Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women. BMJ Open 2016; 6:e011022. [PMID: 27491667 PMCID: PMC4985871 DOI: 10.1136/bmjopen-2015-011022] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women. METHOD A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting one's own sample. RESULTS Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38 years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87). CONCLUSIONS Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.
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Affiliation(s)
- Mahirah Ma'som
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- National Clinical Research Centre, Ministry of Health, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nazrila Hairizan Nasir
- Selangor State Health Department, Klinik Kesihatan Pandamaran, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jerome Bellinson
- Preventive Oncology International Inc, Cleveland Heights, Ohio and The Women's Health Institute of the Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Yuntong Ma
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Siew-Hwei Yap
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Pik-Pin Goh
- National Clinical Research Centre, Ministry of Health, Malaysia
| | - Patti Gravitt
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
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Women's Attitudes Toward Cervicovaginal Self-Sampling for High-Risk HPV Infection on the US-Mexico Border. J Low Genit Tract Dis 2016; 19:323-8. [PMID: 26360234 DOI: 10.1097/lgt.0000000000000134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the acceptability and intention to use cervicovaginal self-sampling for high-risk human papillomavirus infection after receiving an educational intervention among the predominantly Hispanic population residing along the US-Mexico border. METHODS Women received an educational intervention about cervical cancer prevention through screening with conventional cytology and with self-sampling for high-risk human papillomavirus. After the educational intervention, women performed the self-sampling test. Women's attitudes toward the self-sampling test and cervical cytology were assessed and compared. RESULTS A total of 110 women aged 30 to 65 years completed the study. The mean (SD) age of the population was 48 (9.3) years. Most (87%) self-identified as being Hispanic and half were born in Mexico; 16% had not had cervical cytology done in 3 years. Self-sampling was more acceptable than cervical cytology; mean (SD) acceptability scores were 25.0 (2.9) and 22.7 (3.0), respectively, with the maximum possible score being 28 (p < .001). A large proportion (42.7%) of women preferred both tests equally. We found high intention to use and recommend self-sampling. Contrary to previous studies, there were no differences between cervical cytology and self-sampling regarding women's concerns about performing the test well and the accuracy of the test, which we attribute to the educational intervention. CONCLUSION The high acceptability of self-sampling after participants received education about the test and the reported intention to use it if made available add to the evidence on the feasibility of integrating self-testing within cervical cancer screening guidelines.
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Esber A, McRee AL, Norris Turner A, Phuka J, Norris A. Factors influencing Malawian women's willingness to self-collect samples for human papillomavirus testing. ACTA ACUST UNITED AC 2016; 43:135-141. [PMID: 26944955 DOI: 10.1136/jfprhc-2015-101305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/29/2015] [Accepted: 01/31/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malawi has the highest incidence of cervical cancer in the world. Only 3% of Malawian women have ever been screened for cervical cancer. Self-collection of samples for human papillomavirus (HPV) testing could increase screening among under-screened and hard-to-reach populations. However, little is known about the acceptability of self-collection in rural African settings. AIM We aimed to characterise Malawian women's willingness to self-collect vaginal samples for HPV testing and to identify potential barriers. DESIGN We used data from the baseline wave of a community-based cohort study, collected from July 2014 to February 2015. SETTING Participants were enrolled from the catchment area of a clinic in rural Lilongwe District, Malawi. METHODS We enrolled women aged 15-39 years (n=824). Participants answered questions assessing willingness to self-collect a sample for HPV testing, concerns about testing and other hypothesised correlates of willingness to self-collect. RESULTS Two-thirds (67%) of the women reported willingness to self-collect a vaginal sample in their homes. Awareness of cervical cancer, supportive subjective norms, perceived behavioural control, and clinician recommendations were all positively associated with increased willingness to self-collect samples for HPV testing. Identified barriers to self-testing endorsed by women included: concerns that the test might hurt (22%), that they might not do the test correctly (21%), and that the test might not be accurate (17%). CONCLUSIONS This study suggests that self-collection for HPV testing could be an acceptable cervical cancer screening method in this rural population. Findings identify modifiable beliefs and barriers that can inform the development of effective screening programmes.
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Affiliation(s)
- Allahna Esber
- Doctoral Candidate, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Annie-Laurie McRee
- Assistant Professor, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Abigail Norris Turner
- Associate Professor, Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John Phuka
- Assistant Professor, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Lilongwe, Malawi
| | - Alison Norris
- Assistant Professor, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Wang SM, Hu SY, Chen W, Chen F, Zhao FH, He W, Ma XM, Zhang YQ, Wang J, Sivasubramaniam P, Qiao YL. Feasibility and accuracy evaluation of three human papillomavirus assays for FTA card-based sampling: a pilot study in cervical cancer screening. BMC Cancer 2015; 15:848. [PMID: 26537356 PMCID: PMC4634578 DOI: 10.1186/s12885-015-1882-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 10/30/2015] [Indexed: 12/04/2022] Open
Abstract
Background Liquid-state specimen carriers are inadequate for sample transportation in large-scale screening projects in low-resource settings, which necessitates the exploration of novel non-hazardous solid-state alternatives. Studies investigating the feasibility and accuracy of a solid-state human papillomavirus (HPV) sampling medium in combination with different down-stream HPV DNA assays for cervical cancer screening are needed. Methods We collected two cervical specimens from 396 women, aged 25–65 years, who were enrolled in a cervical cancer screening trial. One sample was stored using DCM preservative solution and the other was applied to a Whatman Indicating FTA Elute® card (FTA card). All specimens were processed using three HPV testing methods, including Hybrid capture 2 (HC2), careHPV™, and Cobas®4800 tests. All the women underwent a rigorous colposcopic evaluation that included using a microbiopsy protocol. Results Compared to the liquid-based carrier, the FTA card demonstrated comparable sensitivity for detecting high grade Cervical Intraepithelial Neoplasia (CIN) using HC2 (91.7 %), careHPV™ (83.3 %), and Cobas®4800 (91.7 %) tests. Moreover, the FTA card showed a higher specificity compared to a liquid-based carrier for HC2 (79.5 % vs. 71.6 %, P = 0.015), comparable specificity for careHPV™ (78.1 % vs. 73.0 %, P > 0.05), but lower specificity for the Cobas®4800 test (62.4 % vs. 69.9 %, P = 0.032). Generally, the FTA card-based sampling medium’s accuracy was comparable with that of liquid-based medium for the three HPV testing assays. Conclusions FTA cards are a promising sample carrier for cervical cancer screening. With further optimization, it can be utilized for HPV testing in areas of varying economic development.
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Affiliation(s)
- Shao-Ming Wang
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Shang-Ying Hu
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Wen Chen
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Feng Chen
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Fang-Hui Zhao
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Wei He
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Xin-Ming Ma
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Yu-Qing Zhang
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
| | - Jian Wang
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China. .,Beijing Municipal Institute of Labour Protection, Beijing, 100021, China.
| | - Priya Sivasubramaniam
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China. .,Vanderbilt University School of Medicine, Nashville, TN, 37212, USA.
| | - You-Lin Qiao
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, P.O. Box 2258, 17 South Panjiayuan Lane, Beijing, 100021, China.
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Racey CS, Gesink DC. Barriers and Facilitators to Cervical Cancer Screening Among Women in Rural Ontario, Canada: The Role of Self-Collected HPV Testing. J Rural Health 2015; 32:136-45. [PMID: 26265118 DOI: 10.1111/jrh.12136] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE The addition of human papillomavirus (HPV) testing to primary cervical cancer screening provides an opportunity to employ less invasive cervical cancer screening modalities. The objective of this study was to explore the initial reaction and perception to HPV self-collected testing, in the context of current barriers and facilitators to cervical cancer screening, among women in an underscreened community in rural Ontario. METHODS Age-stratified focus groups were conducted with women 18-70 years of age in rural Ontario to discuss cervical cancer screening. Women were recruited using purposive sampling of underscreened women and women in the general community. Qualitative thematic analysis of focus group transcripts identified the barriers, facilitators, and role of HPV self-collected testing for cervical cancer screening. RESULTS Four focus groups were conducted with a total of 25 women. Overall, women were very positive toward self-collected HPV testing. HPV self-collected testing was felt to address many of the logistical (eg, inconvenient clinic hours, lack of time) and procedural barriers (embarrassment, lack of social distance in a small town) to current screening practices. However, self-collected HPV testing does not address barriers related to cervical cancer knowledge (eg, fear of cancer). Women identified issues related to test reliability, confidence in the ability to self-collect, and education around testing that would need to be addressed prior to implementation. Generational differences were noted in the acceptability of self-collected HPV testing between older and younger women. CONCLUSIONS HPV self-collected testing was perceived as a facilitator for screening, and it was well accepted in this rural community.
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Affiliation(s)
- C Sarai Racey
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dionne C Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Othman NH, Mohamad Zaki FH. Self-collection tools for routine cervical cancer screening: a review. Asian Pac J Cancer Prev 2015; 15:8563-9. [PMID: 25374168 DOI: 10.7314/apjcp.2014.15.20.8563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Sub-optimal participation is a major problem with cervical cancer screening in developing countries which have no organized national screening program. There are various notable factors such as 'embarrassment', 'discomfort' and 'no time' cited by women as they are often also the bread winners for the family. Implementation of self-sampling methods may increase their participation. The aim of this article was to provide a survey of various types of self-sampling tools which are commonly used in collection of cervical cells. We reviewed currently available self-sampling devices and collated the advantages and disadvantages of each in terms of its acceptance and its accuracy in giving desired results. In general, regardless of which device is used, self-sampling for cervical scrapings is highly acceptable to women in most of the studies cited.
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Affiliation(s)
- Nor Hayati Othman
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia E-mail :
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Wang SM, Hu SY, Chen F, Chen W, Zhao FH, Zhang YQ, Ma XM, Qiao YL. Clinical Evaluation of Human Papillomavirus Detection by careHPVTMTest on Physician-Samples and Self-Samples using The Indicating FTA Elute® Card. Asian Pac J Cancer Prev 2014; 15:7085-9. [DOI: 10.7314/apjcp.2014.15.17.7085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Quincy BL. Acceptability of self-collected human papillomavirus specimens in cervical cancer screening: A review. World J Obstet Gynecol 2014; 3:90-97. [DOI: 10.5317/wjog.v3.i3.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/03/2014] [Accepted: 06/16/2014] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer morbidity and mortality is an important public health problem around the world. Some of the barriers to cervical cancer screening include the embarrassment, discomfort, lack of privacy and time and cost associated with clinician-collected, clinic-based screening with cytology or human papillomavirus tests. Self-collection of a human papillomavirus (HPV) test has been found to be generally more acceptable, less embarrassing, more comfortable, more private and easy to do and preferred to pelvic examination for cervical cytology by many women worldwide. The most commonly reported limitation to self-collection is a woman’s lack of confidence in her ability to perform it correctly. Self-collected human papillomavirus tests have been shown to be as or more sensitive than cytology or clinician-collected HPV tests. With confidence-building education about self-collection, it is likely a viable method to extend the reach of screening in high and low-resource areas around the world.
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CareHPV cervical cancer screening demonstration in a rural population of north India. Eur J Obstet Gynecol Reprod Biol 2014; 176:75-9. [DOI: 10.1016/j.ejogrb.2014.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/04/2013] [Accepted: 03/04/2014] [Indexed: 01/05/2023]
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Uijterwaal MH, Verhoef VMJ, Snijders PJF, Meijer CJLM. Arguments in favor of HPV testing for cervical screening and post-treatment CIN2+ monitoring. Expert Rev Mol Diagn 2014; 14:245-8. [DOI: 10.1586/14737159.2014.893829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bosgraaf RP, Siebers AG, De Hullu JA, Massuger LFAG, Bulten J, Bekkers RLM, Melchers WJG. The current position and the future perspectives of cervical cancer screening. Expert Rev Anticancer Ther 2013; 14:75-92. [DOI: 10.1586/14737140.2014.856273] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Miles A, Rodrigues V, Sevdalis N. The effect of information about false negative and false positive rates on people's attitudes towards colorectal cancer screening using faecal occult blood testing (FOBt). PATIENT EDUCATION AND COUNSELING 2013; 93:342-349. [PMID: 23850021 DOI: 10.1016/j.pec.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/13/2013] [Accepted: 06/15/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the impact of numeric risk information about false negative (FN) and false positive (FP) rates in faecal occult blood testing (FOBt) on attitudes towards screening. METHODS 95 people aged 45-59, living in England, read 6 hypothetical vignettes presented online about the use of FOB testing to detect bowel cancer, in which information about FN and FP rates was systematically varied. RESULTS Both verbal and numeric FN risk information reduced people's interest in screening compared with no FN information. Numeric FN risk information reduced people's perceptions of screening effectiveness and lowered perceived trust in the results of screening compared with both verbal FN information and no FN information. FP information did not affect attitudes towards FOB testing. There was limited evidence that FN information reduced interest and perceptions of screening effectiveness more in educated groups. CONCLUSION Numeric FN risk information decreased people's perceptions of screening effectiveness and trust in the results of screening but did not affect people's interest in screening anymore than verbal FN risk information. PRACTICE IMPLICATIONS Numeric FN information could be added to patient information without affecting interest in screening, although this needs to be replicated in a larger, more representative sample.
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Affiliation(s)
- Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.
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Vanderpool RC, Jones MG, Stradtman LR, Smith JS, Crosby RA. Self-collecting a cervico-vaginal specimen for cervical cancer screening: an exploratory study of acceptability among medically underserved women in rural Appalachia. Gynecol Oncol 2013; 132 Suppl 1:S21-5. [PMID: 24125753 DOI: 10.1016/j.ygyno.2013.10.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/26/2013] [Accepted: 10/01/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Innovative screening methods such as self-testing for human papillomavirus (HPV) may alleviate barriers to cervical cancer screening. The purpose of this exploratory study was to determine whether Appalachian Kentucky women would be amenable to self-collecting a cervico-vaginal specimen for HPV testing. METHODS Women aged 30-64 who were overdue for guideline-recommended cervical cancer screening were recruited from a primary care clinic in southeastern Kentucky. The women were asked to self-collect a specimen, using a cervico-vaginal brush, based on verbal and printed directions provided by a research nurse. All study participants, regardless of laboratory-confirmed HPV status, received the same counseling on the importance of cervical cancer screening and offered navigation to follow-up Pap testing at the local health department. RESULTS Thirty-one women were approached and recruited to participate in the study, indicating a 100% acceptance rate of HPV self-testing. Of the 31 women, 26 tested negative for high-risk HPV and five tested positive. All of the women with negative results declined nurse navigation to Pap testing, whereas four of the five women with positive results accepted nurse navigation and received subsequent Pap smear screenings (all results were normal). CONCLUSIONS Among this sample of Appalachian Kentucky women, self-collecting a cervico-vaginal specimen for HPV testing was highly acceptable. This exploratory study provides impetus for larger studies among high-risk, medically underserved women in rural communities. Tailoring alternative cancer screening strategies to meet the complex needs of rural women is likely to lead to reductions in cervical cancer incidence and mortality among this vulnerable population.
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Affiliation(s)
- Robin C Vanderpool
- Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA.
| | - Maudella G Jones
- University of Kentucky Rural Cancer Prevention Center, Hazard, KY, USA
| | - Lindsay R Stradtman
- Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Richard A Crosby
- Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA
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Guan Y, Gravitt PE, Howard R, Eby YJ, Wang S, Li B, Feng C, Qiao YL, Castle PE. Agreement for HPV genotyping detection between self-collected specimens on a FTA cartridge and clinician-collected specimens. J Virol Methods 2013; 189:167-71. [PMID: 23370404 DOI: 10.1016/j.jviromet.2012.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/05/2012] [Accepted: 11/08/2012] [Indexed: 02/03/2023]
Abstract
The current method of transporting self-collected cervicovaginal specimen for HPV DNA testing relies on liquid based medium, which is challenging and expensive to transport. A novel, dry storage and transportation device, Whatman indicating FTA™ Elute Cartridge, avoids some of the pitfalls of liquid-based medium. This method has been shown to be comparable to liquid-based collection medium, but relative performance of self-collected (SC) and clinician-collected (CC) samples onto FTA cards has not been reported. The objective of this study is to compare the analytic performance of self- and clinician-collected samples onto FTA cartridges for the detection of carcinogenic HPV using Linear Array. There was a 91% agreement, 69% positive agreement, and kappa of 0.75 between the clinician-collected and self-collected specimens for detection of any carcinogenic HPV genotype. When the HPV results were categorized hierarchically according to cervical cancer risk, there was no difference in the distribution of the HPV results for the clinician- and self-collected specimens (p=0.7). This study concludes that FTA elute cartridge is a promising method of specimen transport for cervical cancer screening programs considering using self-collected specimen and HPV testing. Larger studies with clinical endpoints are now needed to assess the clinical performance.
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Affiliation(s)
- Yaoyao Guan
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.
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