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Cited by 10Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Acceptability and validity of HPV self‐sampling for cervical cancer screening among women living in different ecological settings in India

Open access
Mishra, Gauravi A., Pimple, Sharmila A., Anand, Kavita V., Kulkarni, Vasundhara Y., Patil, Anil S., Biswas, Sanjay K.·2025·International Journal of Cancer
DOI 10.1002/ijc.35222PMC PMC11737002
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Abstract

India records one fifth of global cervical cancer burden. Unlike human papillomavirus (HPV) self‐sampling, other screening methods may cause discomfort and embarrassment. This study aimed to investigate attitudes, acceptability, barriers, predictors, effective modality of instructions, and validity of HPV self‐sampling among Indian women residing in varied settings and different literacy levels. This is community‐based interventional study among Indian women 30–55 years, residing in urban slums (500), urban non‐slums (500), and rural (600) settings with varied washroom facilities and privacy, to collect self‐samples. Each group was subdivided into two arms; in one women received education with pamphlets and other with health education program (HEP). Study involved enlisting eligibles, obtaining informed consents and conducting personal interviews to collect baseline data. Self‐samplers were distributed with instructions (pictorial pamphlets in one group and HEP in other) regarding usage, storage and return. Willingness to use self‐samplers, refusals, experiences, and so forth were captured. Post‐intervention knowledge, attitudes, practices was recorded. HPV reports were distributed. Women with positive result on either test were offered further management. Acceptance rate of self‐sampling was 99.2%, 97%, and 98.8% and HPV positivity was 7%, 7.8%, and 8.5%, respectively among urban non‐slum, urban slum and rural women. Agreement rate between health personnel collected and self‐collected samples was 96.5% in pamphlet and 93.2% in HEP arm. Major barriers of self‐sampling were lack of confidence about performing self‐test correctly, fear that test would be painful and anxiety about test results. HPV self‐sampling has good acceptability among Indian women and good agreement with health personnel collected samples.

AI snapshot

Written from the paper’s full text.

TL;DR

In a community-based study of 1600 women aged 30–55 in Maharashtra, India, HPV self-sampling was highly acceptable and showed moderate agreement with health personnel-collected samples. The authors conclude self-sampling is feasible and valid for cervical cancer screening in varied Indian settings.

Key findings

  • Self-sampling acceptance was 99.2% among urban non-slum, 97% among urban slum, and 98.8% among rural women; overall, 1574/1600 (98.38%) collected self-samples, and all 26 refusals occurred in the pamphlet arm, while HEP-arm acceptance was 100% in all settings.
  • HPV positivity was 7.00% in urban non-slum, 7.80% in urban slum, and 8.50% in rural women; overall prevalence was 7.81% (95% CI 6.545%–9.238%).
  • Agreement between self-collected and HCP-collected samples was 94.82% overall (k = 0.508, 95% CI 0.458–0.559); it was 96.47% (k = 0.588) in the pamphlet arm and 93.23% (k = 0.454) in the HEP arm.
  • At CIN1 cutoff, HPV-SS had sensitivity 87.50%, specificity 95.02%, PPV 8.24%, and NPV 99.93%; at ≥CIN2 cutoff, sensitivity was 66.67%, specificity 94.72%, PPV 2.35%, and NPV 99.93%.

Methods

  • Community-based interventional study in Maharashtra, India, enrolling 1600 sexually active women aged 30–55: 500 urban slum, 500 urban non-slum, and 600 rural; pregnant women, women with frank cervical cancer, and women with hysterectomy were excluded.
  • Each cluster was divided by cluster randomization into a health education program (HEP) arm or a pictorial pamphlet arm; women completed baseline and post-intervention KAP questionnaires, received self-samplers, and also provided HCP-collected samples.
  • HPV testing used Hybrid Capture System II for 13 high-risk HPV types; analysis included Cohen’s kappa for agreement, McNemar test for pre/post KAP, Clopper-Pearson for HPV prevalence, and diagnostic test characteristics, with α = .05.

Limitations

  • The paper states that post-intervention information was collected mostly within a day, possibly reflecting short-term retention; combined pamphlet-plus-HEP modality was not explored; long-term follow-up on cervical cancer rates and integration into routine screening was not included; no qualitative component explored barriers/experiences; no cost-effectiveness analysis was done; and the study was conducted in one Indian State, so national generalizability needs verification.
  • Evident from the text: agreement analyses included 1505 women with both samples, positive agreement was low (36.59% overall), and only 96 of 125 HPV-positive women complied for further clinical assessment, so validity and follow-up findings rest on subsets of the enrolled population.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/ijc.35222

Cites

38 of 39 references verified1 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 12 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    More women accepted self-sampling (1574) as compared to HCP-collected samples (1531).

    “More women accepted self‐sampling (1574) as compared to HCP‐collected samples (1531).”
    Quote in the paperSubstantial claim
  • Findingown data

    Totally, 1574 (98.38%) women collected self-samples.

    “Totally, 1574 (98.38%) women collected self‐samples.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was a significant positive change in attitude (p < .001) for screening across all three settings.

    “There was also a significant positive change in attitude (p < .001) for screening across all three settings (Table S2).”
    Quote in the paperSubstantial claim
  • Findingown data

    Agreement rate between HCP-collected and self-collected samples was 96.47% in the pamphlet arm.

    “Agreement was 96.47% (k = 0.588 [95% CI = 0.516–0.660, p = 1.59992E‐57]) in pamphlet arm and 93.23% (k = 0.454 [95% CI = 0.383–0.525, p = 2.32049E‐36]) in HEP arm.”
    • Also stated in: § Abstract · plain
      “Agreement rate between health personnel collected and self‐collected samples was 96.5% in pamphlet and 93.2% in HEP arm.”
    Quote in the paperSubstantial claim
  • Findingown data

    Agreement rate between HCP-collected and self-collected samples was 93.23% in the HEP arm.

    “Agreement was 96.47% (k = 0.588 [95% CI = 0.516–0.660, p = 1.59992E‐57]) in pamphlet arm and 93.23% (k = 0.454 [95% CI = 0.383–0.525, p = 2.32049E‐36]) in HEP arm.”
    • Also stated in: § Abstract · plain
      “Agreement rate between health personnel collected and self‐collected samples was 96.5% in pamphlet and 93.2% in HEP arm.”
    Quote in the paperSubstantial claim
  • May combine two claims. 27
  • Classified as probably not a substantial claim. 15
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    Other screening methods may cause discomfort and embarrassment, unlike HPV self-sampling.

    “In addition, major concerns of women with clinic‐based approach are that, women may perceive procedures as unpleasant, embarrassing, preference to be screened by female health care provider, physical, and/or psychological discomfort associated with the test and time off required from work in order to attend screening clinic. 15”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Maar M, Burchell A, Little J, et al. A qualitative study of provider perspectives of structural barriers to cervical cancer screening among first nations women. Womens Health Issues. 2013; 23(5): e319‐ e325. doi: 10.1016/j.whi.2013.06.005 23993479 PMC4111655 source

  • May combine two claims.

    Premisecitation

    HPV-based screening tests are reproducible, have higher sensitivity for detecting high-grade CIN, and have very good negative predictive values (NPVs) as compared to cytology.

    “HPV‐based screening tests are reproducible, have higher sensitivity for detecting high‐grade CIN, and have very good negative predictive values (NPVs) as compared to cytology. 13 , 14”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [13] Sankaranarayanan R. Screening for cancer in low‐ and middle‐income countries. Ann Glob Health. 2014; 80(5): 412‐ 417. doi: 10.1016/j.aogh.2014.09.014 25512156 source

      The ‘Suitable Cancers and Tests for Screening’ section says that screening tests generally have NPVs exceeding 99%, and the ‘Screening for Cervical Cancer’ section says HPV testing can identify CIN. Neither section establishes that HPV tests are reproducible or have higher sensitivity or NPV than cytology. Page numbers are unavailable in our copy. (LLM, conf=0.71)

      Experimental — accuracy not yet measured
    • cites [14] National Cancer Grid (NCG) of India. Tata Memorial Center. Consensus Evidence Based Resource Stratified Guidelines on Secondary prevention of Cervical, Breast & Oral Cancers. NCG Working Group. Resource Stratified Guidelines for Preventive Oncology and Primary Care. Accessed June 14, 2023. https://tmc.gov.in/ncg/docs/PDF/DraftGuidelines/Preventive/3_%20NCG_INDIA_Rev_Preventive%20Oncology_Primary_Care.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Several studies in different countries have demonstrated self-sampling for HPV to be a cost effective, easy, feasible, and well-accepted method with high accuracy.

    “Several studies in different countries have demonstrated self‐sampling for HPV to be a cost effective, easy, feasible, and well‐accepted method with high accuracy. 16 , 17”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [16] Nelson EJ, Maynard BR, Loux T, Fatla J, Gordon R, Arnold LD. The acceptability of self‐sampled screening for HPV DNA: a systematic review and meta‐analysis. Sex Transm Infect. 2017; 93(1): 56‐ 61. doi: 10.1136/sextrans-2016-052609 28100761 source
    • cites [17] Madhivanan P, Nishimura H, Ravi K, et al. Acceptability and concordance of self‐ versus clinician‐sampling for HPV testing among rural south Indian women. Asian Pac J Cancer Prev. 2021; 22(3): 971‐ 976. doi: 10.31557/APJCP.2021.22.3.971 33773563 PMC8286674 source

      The Introduction (page not provided) cites high acceptability across studies in 24 countries, and the Discussion reports that self-sampling was feasible and acceptable in rural India, with accuracy comparable to clinician sampling. The paper describes HPV DNA testing as a low-cost option, but does not establish that self-sampling itself is cost-effective. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Assuming HPV prevalence among the women to be 7%-10% and concordance rate of 80%, at 95% confidence interval and power of 80%, around 1600 women were needed to undergo HPV testing by both methods.

    “Sample size: Assuming HPV prevalence among the women to be 7%–10% based on the published reports, 19 , 20 and concordance rate of 80%, at 95% confidence interval (CI) and power of 80%, between samples collected by HCW and self‐collected samples, around 1600 women were needed to undergo HPV testing by both the methods.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [19] Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009; 360(14): 1385‐ 1394. doi: 10.1056/NEJMoa0808516 19339719 source
    • cites [20] Sowjanya AP, Jain M, Poli UR, et al. Prevalence and distribution of high‐risk human papilloma virus (HPV) types in invasive squamous cell carcinoma of the cervix and in normal women in Andhra Pradesh, India. BMC Infect Dis. 2005; 5: 116. Published 2005 Dec 22. doi: 10.1186/1471-2334-5-116 16371167 PMC1345691 source
    • The authors state this as an assumption: HPV prevalence among the women is 7%–10%.
    • The authors state this as an assumption: Concordance rate between HCW and self-collected samples is 80%.

  • May combine two claims.

    Findingown data

    Acceptance rate of self-sampling was 99.2% among urban non-slum, 97% among urban slum, and 98.8% among rural women.

    “Acceptance rate of self‐sampling was 99.2%, 97%, and 98.8% and HPV positivity was 7%, 7.8%, and 8.5%, respectively among urban non‐slum, urban slum and rural women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    HPV positivity was 7% among urban non-slum, 7.8% among urban slum, and 8.5% among rural women.

    “Acceptance rate of self‐sampling was 99.2%, 97%, and 98.8% and HPV positivity was 7%, 7.8%, and 8.5%, respectively among urban non‐slum, urban slum and rural women.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    All except one woman completed treatment.

    “All except one woman completed the treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Acceptance of self-sampling was similar among women who received information with health education and among women who received information with pamphlets, except that among urban slum women who received pamphlets, acceptance was 88.4% versus 98% with health education.

    “Acceptance was similar among women who received information with health education and among women who received information with pamphlets except that among urban slum women who received information with pamphlets, the acceptance was only 88.4% versus those who received information regarding self‐collection by HEP wherein acceptance was 98%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Test characteristics of HPV by HCP at cutoff CIN1 were sensitivity 87.50%, specificity 94.88%, FPR 5.12%, FNR 12.50%, PPV 8.24%, NPV 99.93%.

    “The test characteristics of HPV‐SS and HPV by HCP in terms of sensitivity, specificity, FPR, FNR, PPV, and NPV were 87.50%, 95.02%, 4.98%, 12.50%, 8.24%, 99.93% and 87.50%, 94.88%, 5.12%, 12.50%, 8.24%, 99.93%, respectively at cutoff of CIN1”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Self-sampling was accepted by 99.2% of urban non-slum women, 97% of urban slum women, and 98.8% of rural women.

    “Self‐sampling was accepted by 99.2% of urban non‐slum women, 97% of urban slum women, and 98.8% of rural women.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Test characteristics of HPV-SS at cutoff CIN1 were sensitivity 87.50%, specificity 95.02%, FPR 4.98%, FNR 12.50%, PPV 8.24%, NPV 99.93%.

    “The test characteristics of HPV‐SS and HPV by HCP in terms of sensitivity, specificity, FPR, FNR, PPV, and NPV were 87.50%, 95.02%, 4.98%, 12.50%, 8.24%, 99.93% and 87.50%, 94.88%, 5.12%, 12.50%, 8.24%, 99.93%, respectively at cutoff of CIN1”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Illiteracy was maximum among rural women (13.50%) followed by urban slum women (11.40%).

    “In this study, illiteracy was maximum among rural women (13.50%) followed by women from urban slums (11.40%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In this study, screening was mainly advised by family physicians and community health workers.

    “In this study, screening was mainly advised by family Physician and community health workers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the 96 women who complied for referral, colposcopy identified lesions in 25 (26%) women, and cervical biopsies were undertaken.

    “Colposcopy was performed among 96 women who complied for referral, lesions were identified on Colposcopy among 25 (26%) women, and hence cervical biopsies were undertaken.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Test characteristics of HPV by HCP at cutoff ≥CIN2 were sensitivity 66.67%, specificity 94.57%, FPR 5.43%, FNR 33.33%, PPV 2.35%, NPV 99.93%.

    “and 66.67%, 94.72%, 5.28%, 33.33%, 2.35%, 99.93% and 66.67%, 94.57%, 5.43%, 33.33%, 2.35%, 99.93% at cutoff of ≥CIN 2, respectively.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Median age of marriage was 22, 19, and 20 years among urban non-slum, urban slum, and rural women, respectively.

    “The median age of marriage was 22, 19, and 20 years among the urban non‐slum, urban slum, and rural women in this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Test characteristics of HPV-SS at cutoff ≥CIN2 were sensitivity 66.67%, specificity 94.72%, FPR 5.28%, FNR 33.33%, PPV 2.35%, NPV 99.93%.

    “and 66.67%, 94.72%, 5.28%, 33.33%, 2.35%, 99.93% and 66.67%, 94.57%, 5.43%, 33.33%, 2.35%, 99.93% at cutoff of ≥CIN 2, respectively.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Compliance with referral was least among rural women (68.63%), followed by urban non-slum women (77.14%), and best among urban slum women (87.18%).

    “Compliance was least among rural women (68.63%), followed by urban non‐slum women (77.14%) and was best among urban slum women (87.18%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In total, 125 women were positive on either test; 85 each on self-sampled (SS) and HCP-collected samples.

    “In total, 125 women were positive on either test; 85 each on SS and HCP collected sample.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    On histopathology, 5 women were diagnosed with CIN 1, 1 with CIN 2, and 2 with CIN 3.

    “On histopathology examination, 5 women were diagnosed with CIN 1, 1 women with CIN 2, and 2 women with CIN 3.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Median age at enrollment in the trial was 40 years.

    “In the current trial, the median age at enrollment of women was 40 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was moderate agreement between HPV-HCP collected samples and HPV-SS; 94.82% (k = 0.508 [95% CI = 0.458-0.559]).

    “There was moderate agreement between the HPV‐HCP collected samples and HPV‐SS; 94.82% (k = 0.508 [95% CI = 0.458–0.559, p = 1.5124E‐86]).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Less than 3% of Indian women between 30 and 49 years are ever screened (2.2% in urban and 1.7% in rural).

    “Though India has the highest number of cervical cancer cases, <3% of Indian women between 30 and 49 years are ever screened, (2.2% in urban and 1.7% in rural). 2”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] National Family and Health Survey NFHS 5, 2019–21. Ministry of Health and Family Welfare. India Fact Sheet. International Institute of Population Sciences. Accessed June 9, 2023. http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    Persistent infection with carcinogenic human papillomavirus (HPV) is responsible for virtually all cases of cervical intraepithelial neoplasia (CIN) and invasive cancers.

    “Persistent infection with carcinogenic human papilloma virus (HPV) is responsible for virtually all cases of cervical intraepithelial neoplasia (CIN) and invasive cancers. 3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] World Health Organisation. Cervical Cancer Fact Sheets. Accessed June 14, 2023. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Cytology-based screening is labor- and time-intensive and lacks sensitivity and reproducibility to detect CIN or cervical cancer.

    “Cytology‐based screening is labor‐ and time‐intensive and lacks sensitivity and reproducibility to detect CIN or cervical cancer. 4 , 5”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Stoler MH, Schiffman M. Atypical squamous cells of undetermined significance‐low‐grade squamous intraepithelial lesion triage study (ALTS) group. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS‐LSIL triage study. Jama. 2001; 285(11): 1500‐ 1505. doi: 10.1001/jama.285.11.1500 11255427 source
    • cites [5] Nanda K, McCrory DC, Myers ER, et al. Accuracy of the Papanicolaou test in screening for and follow‐up of cervical cytologic abnormalities: a systematic review. Ann Intern Med. 2000; 132(10): 810‐ 819. doi: 10.7326/0003-4819-132-10-200005160-00009 10819705 source

  • May combine two claims.

    Study design and conductreasoning

    Post-intervention information was collected mostly within a day, which might have led to short-term retention of information, reflected as increase in knowledge.

    “Some of the limitations of the study are, post‐intervention information was collected mostly within a day and that might have led to short‐term retention of information, reflected as increase in knowledge.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Interpretationown data

    Poor prior screening uptake could be multifactorial, including lack of deeper understanding, difficulty in access, stigma, cultural barriers, patriarchal social system, and social/economic dependency on men.

    “The reasons for poor prior screening uptake could be multifactorial, including, lack of deeper understanding regarding causes and symptoms, (Figure 2) difficulty in access and availability of only limited number of screening facilities, stigma, cultural barriers—including embarrassment associated with gynecological examination, patriarchal social system with inequitable gender‐based power dynamics”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Checks for consistency, data safety, data errors, and analysis were carried out at regular intervals.

    “Checks for consistency, data safety, data errors, and analysis were carried out at regular intervals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    These findings highlight the importance of self-testing methods that provide women with increased accessibility, autonomy, and control during the examination.

    “These findings highlight importance of self‐testing methods that provide women with increased accessibility, autonomy and control during the examination.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The two worries (feeling more confident with HCP and concern about pain/hurting self) were commonly observed across all surveyed sites.

    “These two worries were commonly observed across all the surveyed sites.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    This study was conducted in one State in India, though in different settings.

    “Finally, this study was conducted in one State in India, though in different settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study does not reflect comprehensive understanding of effectiveness of HPV self-sampling, as long-term follow-up data on impact on cervical cancer rates and integration into routine screening programs were not part of trial objectives.

    “The study does not reflect comprehensive understanding of effectiveness of HPV self‐sampling, as the long‐term follow‐up data of the impact of self‐sampling on cervical cancer rates and its integration into routine screening programs were not part of the trial objectives.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Cost-effectiveness analysis was not part of this study, so economic implications and potential for scalability of HPV self-sampling in resource-limited settings could not be explored.

    “Cost‐effectiveness analysis was not part of this study and hence the economic implications and potential for scalability of HPV self‐sampling in resource‐limited settings could not be explored.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The trial was approved by the Institutional Ethics Committee and registered with the clinical trials registry.

    “The trial was approved by the Institutional Ethics Committee and registered with the clinical trials registry.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Women from each of the three clusters were divided into two arms (HEP and pamphlet) by cluster randomization.

    “Women from each of the three clusters were divided into two arms (viz., HEP arm and pamphlet arm) again by cluster randomization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    NFHS 5 survey records 1.9% women being ever screened for cervical cancer.

    “NFHS 5 survey records 1.9% women being ever screened for cervical cancer.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] National Family and Health Survey NFHS 5, 2019–21. Ministry of Health and Family Welfare. India Fact Sheet. International Institute of Population Sciences. Accessed June 9, 2023. http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The use of combined modality (pamphlets and health education) has not been explored.

    “Another limitation is that the use of combined modality (pamphlets and health education) has not been explored.”
    Quote in the paperNot a substantial claim
37 of 37

  • The authors state this as an assumption.

    HPV prevalence among the women is 7%–10%.

    “Assuming HPV prevalence among the women to be 7%–10% based on the published reports, 19 , 20”

  • The authors state this as an assumption.

    Concordance rate between HCW and self-collected samples is 80%.

    “and concordance rate of 80%, at 95% confidence interval (CI) and power of 80%, between samples collected by HCW and self‐collected samples”

  • The paper relies on this without support.

    HCP-collected samples provide a valid reference standard for HPV detection.

    “The agreement between HCP‐collected samples and self‐collected samples is depicted in Table 2.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Self-collection is highly acceptable across settings internationally and helps overcome major barriers to cervical screening using cytology or VIA.

    “Self-collection is highly acceptable across settings internationally and helps overcome some of the major barriers to cervical screening using cytology or VIA, including stigma, shame, embarrassment, past trauma, fear and shortage of time, space, and healthcare workers to undertake speculum-based screening.913”

    From Protocol for a cervical screening implementation trial comparing two approaches for delivering HPV self-collection in low-resource settings in India: a type 3 hybrid cluster randomised controlled trial (SHE-CAN) (2025) · cites this paper as [13]

    The Introduction says studies in several countries found HPV self-sampling well accepted and explains that avoiding a speculum examination can reduce discomfort and allow testing at home. The Discussion reports high acceptance across the study’s urban and rural Indian settings and identifies stigma and embarrassment as screening barriers. Our copy does not establish that self-collection overcomes past trauma or shortages of screening space and healthcare workers, as the full citing sentence claims. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Agreement is described as moderate in every setting despite a fair rating

    Minor

    The discussion says agreement was moderate in all settings, but Table 2 rates overall agreement in the urban non-slum setting as fair, with kappa 0.390.

  • Self-sampling acceptance rates in urban slums are misstated

    Minor

    The discussion gives 88.4% and 98% as self-sampling acceptance rates for the urban-slum pamphlet and HEP arms. The results instead report 94% and 100%, respectively; 88.4% and 98% are the rates for health-personnel-collected samples.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Global Cancer Observatory, 2022, GLOBOCAN
  2. 2021, WHO Guideline for Screening and Treatment of Cervical Pre‐Cancer Lesions for Cervical Cancer Prevention
  3. digene®, 2020, HC2 HPV DNA Test Instructions for Use

Cited by

Sorted by citations

Related

Authors
Mishra, G. A., Pimple, S. A., Anand, K. V., Kulkarni, V. Y., Patil, A. S., & Biswas, S. K.
Affiliations
Homi Bhabha National Institute (IN)
Corresponding author
Mishra, Gauravi A.
ORCID
Venue
International Journal of Cancer
Publisher
Wiley
Published
2024-10-16
Volume
156
Issue
6
Pages
1142-1153
ISSN
  • 0020-7136 (ISSN-L)
  • 1097-0215
DOI
10.1002/ijc.35222
PMC
PMC11737002
OpenAlex
W4403464719
Cited by
10
References
38
Citations by year
2026: 7 · 2025: 3
FWCI
2.60
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Cancer (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
Terry Fox Foundation (I1050)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
HPV self-sampling, cervical cancer screening, self-collected cervical samples, acceptability, validity, health education intervention, urban slums, rural women, literacy, barriers to screening
MeSH terms
Adult, Uterine Cervical Neoplasms, Female, Humans, India, Health Knowledge, Attitudes, Practice, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Rural Population, Self Care, Specimen Handling, Urban Population, Vaginal Smears, Papillomaviridae, Papillomavirus Infections, Early Detection of Cancer

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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