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Cited by 232Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

Self-collected HPV Testing Improves Participation in Cervical Cancer Screening: A Systematic Review and Meta-analysis

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Racey, C. Sarai, Withrow, Diana R., Gesink, Dionne·2013·Canadian Journal of Public Health
DOI 10.1007/bf03405681PMC PMC6973997
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Abstract

Objective HPV testing has emerged as an effective cervical cancer screening test. The use of HPV self-testing has the potential to address many barriers to screening and reach at-risk women through engagement in screening. However, there is a need to examine the evidence for whether offering self-collected HPV testing in practice increases screening compliance. The objective of this review is to determine to what extent providing self-collected HPV testing increases screening participation in women who are never or underscreened for cervical cancer. Methods A systematic literature review conducted in the databases Medline and Embase identified articles examining the use of HPV self-testing on cervical cancer screening participation. A meta-analysis using a random-effects model was used to calculate the relative compliance, with an intent-to-treat analysis of HPV self-testing compared to Pap testing, with 95% confidence intervals (CI). All statistical tests were two-sided. Synthesis Ten studies were reviewed, with 8 being European and 2 North American. Of the 10 studies, 9 employed a randomized design. In all studies, the relative compliance of HPV self-collected testing compared to Pap testing was significantly greater than 1.0 (p<0.01). The overall relative compliance was 2.14 (95% CI 1.30-3.52). There was large heterogeneity of screening compliance between studies for both HPV self-testing and Pap testing. Conclusion HPV self-collected testing significantly improved the participation of women who did not routinely attend cervical cancer screening programs. New approaches to HPV self-test delivery should be considered as HPV testing becomes more widely incorporated as a primary screening tool.

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  • Two previous participation meta-analyses showed that sending self sampling kits to a woman's home address generated greater response rates than invitation or reminder letters.

    “Two previous participation meta-analyses showed that sending self sampling kits to a woman’s home address generated greater response rates than invitation or reminder letters.23 24”

    From Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses (2018) · cites this paper as [24]

    The Synthesis in our copy (Abstract; page not specified) reports that this meta-analysis found greater screening participation with self-collected HPV testing than with Pap testing. It does not establish the more specific comparison of kits sent to home addresses against invitation or reminder letters, so that part of the claim is unsupported by the available passages. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • HPV DNA self-sampling has been associated with improved participation in cervical cancer screening studies in low-income and middle-income countries.

    “and has been associated with improved participation in cervical cancer screening studies in low-income and middle-income countries.14”

    From HPV self-sampling for cervical cancer screening: a systematic review of values and preferences (2021) · cites this paper as [14]

    The Abstract (page not specified) reports improved screening participation with self-collected HPV testing. But it says the ten studies reviewed were in Europe and North America, so its findings do not establish improved participation in studies in low- and middle-income countries. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • HPV self-sampling has been found to improve screening uptake.

    “Also, HPV self-sampling has been found to improve screening uptake [36].”

    From Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study (2019) · cites this paper as [36]

  • A systematic review of studies that included the option for self-sampling has shown improved participation among women who do not routinely attend screening programs.

    “Furthermore, a systematic review of studies that included the option for self-sampling has shown improved participation among women who do not routinely attend screening programs [11].”

    From A community‐based, cross‐sectional study of hr<scp>HPV DNA</scp> self‐sampling‐based cervical cancer screening in rural Karnataka, India (2019) · cites this paper as [11]

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Research works printed but not linked: 44

  1. [1]Gustafsson L, Ponten J, Zack M, Adami HO. International incidence rates of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control. 1997;865:755–63. doi: 10.1023/A:1018435522475. [DOI] [PubMed] [Google Scholar] · DOI
  2. [2]Decker K, Demers A, Chateau D, Musto G, Nuget Z, Lotocki R, Harrison M. Open Med. 2009. Papanicolaou test utilization and frequency of screening opportunities among women diagnosed with cervical cancer; pp. 140–47. [PMC free article] [PubMed] [Google Scholar]
  3. [3]Black AT, McCulloch A, Martin RE, Kan L. Young women and cervical cancer screening: What barriers persist? Can J Nurs Res. 2011;43(1):8–21. [PubMed] [Google Scholar]
  4. [4]Redwood-Campbell L, Fowler N, Laryea S, Howard M, Kaczorowski J. ‘Before you teach me, I cannot know’: Immigrant women’s barriers and enablers with regard to cervical cancer screening among different ethnolinguistic groups in Canada. Can J Public Health. 2011;02(3):230–34. doi: 10.1007/BF03404903. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  5. [5]Waller J, Jackowska M, Marlow L, Wardle J. Exploring age differences in reasons for nonattendance for cervical screening: A qualitative study. BJOG. 2012;119(1):26–32. doi: 10.1111/j.1471-0528.2011.03030.x. [DOI] [PubMed] [Google Scholar] · DOI
  6. [6]Logan L, McIlfatrick S. Exploring women’s knowledge, experiences and perceptions of cervical cancer screening in an area of social deprivation. Eur J Cancer Care (Engl) 2011;20(6):720–27. doi: 10.1111/j.1365-2354.2011.01254.x. [DOI] [PubMed] [Google Scholar] · DOI
  7. [7]Brown DR, Wilson RM, Boothe MAS, Harris CES. Cervical cancer screening among ethnically diverse black women: Knowledge, attitudes, beliefs, and practices. J Natl Med Assoc. 2011;103(8):719–28. doi: 10.1016/S0027-9684(15)30411-9. [DOI] [PubMed] [Google Scholar] · DOI
  8. [8]Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189(1):12–19. doi: 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F. [DOI] [PubMed] [Google Scholar] · DOI
  9. [9]Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012;137(4):516–42. doi: 10.1309/AJCPTGD94EVRSJCG. [DOI] [PubMed] [Google Scholar] · DOI
  10. [10]Petignat P, Vassilakos P. Is it time to introduce HPV self-sampling for primary cervical cancer screening? J Natl Cancer Inst. 2012;104(3):166–67. doi: 10.1093/jnci/djr544. [DOI] [PubMed] [Google Scholar] · DOI
  11. [11]Agorastos T, Sotiriadis A, Chatzigeorgiou K. Can HPV testing replace the pap smear? Ann N Y Acad Sci. 2010;1205:51–56. doi: 10.1111/j.1749-6632.2010.05661.x. [DOI] [PubMed] [Google Scholar] · DOI
  12. [13]Schiffman M, Wentzensen N, Wacholder S, Kinney W, Gage JC, Castle PE. Human papillomavirus testing in the prevention of cervical cancer. J Natl Cancer Inst. 2011;103(5):368–83. doi: 10.1093/jnci/djq562. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  13. [14]Wright TC., Jr. Cervical cancer screening in the 21st Century: Is it time to retire the PAP smear? Clin Obstet Gynecol. 2007;50(2):313–23. doi: 10.1097/GRF.0b013e31804a8285. [DOI] [PubMed] [Google Scholar] · DOI
  14. [15]Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla P P, Del Mistro A, et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: A randomized controlled trial. Lancet Oncology. 2010;11:249–57. doi: 10.1016/S1470-2045(09)70360-2. [DOI] [PubMed] [Google Scholar] · DOI
  15. [16]Leinonen M, Nieminen P, Kotaniemi-Talonen L, Malila N, Tarkkanen J, Laurila P, et al. Age-specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting. J Natl Cancer Inst. 2009;101(23):1612–23. doi: 10.1093/jnci/djp367. [DOI] [PubMed] [Google Scholar] · DOI
  16. [17]Mayrand M-H, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16):1579–88. doi: 10.1056/NEJMoa071430. [DOI] [PubMed] [Google Scholar] · DOI
  17. [18]Karwalajtys T, Howard M, Sellors JW, Kaczorowski J. Vaginal self sampling versus physician cervical sampling for HPV among younger and older women. Sex Transm Infect. 2006;82(4):337–39. doi: 10.1136/sti.2005.019430. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  18. [19]Ogilvie GS, Patrick DM, Schulzer M, Sellors JW, Petric M, Chambers K, et al. Diagnostic accuracy of self collected vaginal specimens for human papillomavirus compared to clinician collected human papillomavirus specimens: A meta-analysis. Sex Transm Infect. 2005;81(3):207–12. doi: 10.1136/sti.2004.011858. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  19. [20]Petignat P, Faltin DL, Bruchim I, Tramer MR, Franco EL, Coutlee F. Are selfcollected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis. Gynecol Oncol. 2007;105(2):530–35. doi: 10.1016/j.ygyno.2007.01.023. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  20. [21]Moscicki AB, Widdice L, Ma Y, Farhat S, Miller-Benningfield S, Jonte J, et al. Comparison of natural histories of human papillomavirus detected by clinician- and self-sampling. Int J Cancer. 2010;27(8):1882–92. doi: 10.1002/ijc.25199. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  21. [22]Huynh J, Howard M, Lytwyn A. Self-collection for vaginal human papillomavirus testing: Systematic review of studies asking women their perceptions. J Low Genit Tract Dis. 2010;14(4):356–62. doi: 10.1097/LGT.0b013e3181dc115b. [DOI] [PubMed] [Google Scholar] · DOI
  22. [23]Igidbashian S, Boveri S, Spolti N, Radice D, Sandri MT, Sideri M. Self-collected human papillomavirus testing acceptability: Comparison of two selfsampling modalities. J Womens Health (Larchmt) 2011;20(3):397–402. doi: 10.1089/jwh.2010.2189. [DOI] [PubMed] [Google Scholar] · DOI
  23. [24]Wikstrom I, Stenvall H, Wilander E. Attitudes to self-sampling of vaginal smear for human papilloma virus analysis among women not attending organized cytological screening. Acta Obstet Gynecol Scand. 2007;86(6):720–25. doi: 10.1080/00016340701303747. [DOI] [PubMed] [Google Scholar] · DOI
  24. [25]Zehbe I, Moeller H, Severini A, Weaver B, Escott N, Bell C, et al. Feasibility of self-sampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest Ontario, Canada: A pilot study. BMJ Open. 2011;1(1):e000030–e. doi: 10.1136/bmjopen-2010-000030. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  25. [26]Ogilvie G, Krajden M, Maginley J, Isaac-Renton J, Hislop G, Elwood-Martin R, et al. Feasibility of self-collection of specimens for human papillomavirus testing in hard-to-reach women. CMAJ. 2007;177(5):480–83. doi: 10.1503/cmaj.070013. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  26. [27]Schmeink CE, Bekkers RL, Massuger LF, Melchers WJ. The potential role of self-sampling for high-risk human papillomavirus detection in cervical cancer screening. Rev Med Virol. 2011;21(3):139–53. doi: 10.1002/rmv.686. [DOI] [PubMed] [Google Scholar] · DOI
  27. [28]Zhao FH, Lewkowitz AK, Chen F, Lin MJ, Hu SY, Zhang X, et al. Pooled analysis of a self-sampling HPV DNA test as a cervical cancer primary screening method. J Natl Cancer Inst. 2012;104(3):178–88. doi: 10.1093/jnci/djr532. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  28. [30]Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. doi: 10.1136/bmj.327.7414.557. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  29. [31]Bais AG, van Kemenade FJ, Berkhof J, Verheijen RH, Snijders PJ, Voorhorst F, et al. Human papillomavirus testing on self-sampled cervicovaginal brushes: An effective alternative to protect nonresponders in cervical screening programs. Int J Cancer. 2007;20(7):1505–10. doi: 10.1002/ijc.22484. [DOI] [PubMed] [Google Scholar] · DOI
  30. [32]Gok M, Heideman DAM, van Kemenade FJ, Berkhof J, Rozendaal L, Spruyt JWM, et al. HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: Cohort study. BMJ. 2010;340:c1040. doi: 10.1136/bmj.c1040. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  31. [33]Gok M, van Kemenade FJ, Heideman DA, Berkhof J, Rozendaal L, Spruyt JW, et al. Experience with high-risk human papillomavirus testing on vaginal brush-based self-samples of non-attendees of the cervical screening program. Int J Cancer. 2012;130(5):1128–35. doi: 10.1002/ijc.26128. [DOI] [PubMed] [Google Scholar] · DOI
  32. [35]Szarewski A, Cadman L, Mesher D, Austin J, Ashdown-Barr L, Edwards R, et al. HPV self-sampling as an alternative strategy in non-attenders for cervical screening — a randomised controlled trial. Br J Cancer. 2011;104(6):915–20. doi: 10.1038/bjc.2011.48. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  33. [36]Wikstrom I, Lindell M, Sanner K, Wilander E. Self-sampling and HPV testing or ordinary Pap-smear in women not regularly attending screening: A randomised study. Br J Cancer. 2011;105(3):337–39. doi: 10.1038/bjc.2011.236. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  34. [37]Virtanen A, Nieminen P, Luostarinen T, Anttila A. Self-sample HPV tests as an intervention for nonattendees of cervical cancer screening in Finland: A randomized trial. Cancer Epidemiol Biomarkers Prev. 2011;20(9):1960–69. doi: 10.1158/1055-9965.EPI-11-0307. [DOI] [PubMed] [Google Scholar] · DOI
  35. [38]Piana L, Leandri FX, Le Retraite L, Heid P, Tamalet C, Sancho-Garnier H. L’auto-prélèvement vaginal à domicile pour recherche de papilloma virus à haut risque. Campagne expérimentale du département des Bouches-du- Rhône. Bulletin du Cancer. 2011;98(7):723–31. doi: 10.1684/bdc.2011.1388. [DOI] [PubMed] [Google Scholar] · DOI
  36. [39]Lazcano-Ponce E, Lorincz AT, Cruz-Valdez A, Salmeron J, Uribe P, Velasco-Mondragon E, et al. Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): A community-based randomised controlled trial. Lancet. 2011;378(9806):1868–73. doi: 10.1016/S0140-6736(11)61522-5. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  37. [40]Castle PE, Rausa A, Walls T, Gravitt PE, Partridge EE, Olivo V, et al. Comparative community outreach to increase cervical cancer screening in the Mississippi Delta. Prev Med. 2011;52(6):452–55. doi: 10.1016/j.ypmed.2011.03.018. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  38. [41]Edwards JB, Tudiver F. Women’s preventive screening in rural health clinics. Womens Health Issues. 2008;18(3):155–66. doi: 10.1016/j.whi.2008.01.005. [DOI] [PubMed] [Google Scholar] · DOI
  39. [42]Fehringer G, Howlett R, Cotterchio M, Klar N, Majpruz-Moat V, Mai V. Comparison of papanicolaou (Pap) test rates across Ontario and factors associated with cervical screening. Can J Public Health. 2005;96(2):140–44. doi: 10.1007/BF03403678. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  40. [43]Yabroff KR, Lawrence WF, King JC, Mangan P, Washington KS, Yi B, et al. Geographical disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment. J Rural Health. 2005;21(2):149–57. doi: 10.1111/j.1748-0361.2005.tb00075.x. [DOI] [PubMed] [Google Scholar] · DOI
  41. [46]Sowjanya AP, Paul P, Vedantham H, Ramakrishna G, Vidyadhari D, Vijayaraghavan K, et al. Suitability of self-collected vaginal samples for cervical cancer screening in Periurban Villages in Andhra Pradesh, India. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1373–78. doi: 10.1158/1055-9965.EPI-08-1171. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  42. [47]Lindell M, Sanner K, Wikstrom I, Wilander E. Self-sampling of vaginal fluid and high-risk human papillomavirus testing in women aged 50 years or older not attending Papanicolaou smear screening. BJOG. 2012;19(2):245–48. doi: 10.1111/j.1471-0528.2011.03147.x. [DOI] [PubMed] [Google Scholar] · DOI
  43. [48]Sanner K, Wikstrom I, Strand A, Lindell M, Wilander E. Self-sampling of the vaginal fluid at home combined with high-risk HPV testing. Br J Cancer. 2009;01(5):871–74. doi: 10.1038/sj.bjc.6605194. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  44. [49]Stenvall H, Wikstrom I, Wilander E. High prevalence of oncogenic human papilloma virus in women not attending organized cytological screening. Acta Derm Venereol. 2007;87(3):243–45. doi: 10.2340/00015555-0205. [DOI] [PubMed] [Google Scholar] · DOI

Cited by

Sorted by citations

Authors
Racey, C. S., Withrow, D. R., & Gesink, D.
Affiliations
University of Toronto (CA)
Corresponding author
Racey, C. Sarai
ORCID
Venue
Canadian Journal of Public Health
Publisher
Springer Science and Business Media LLC
Published
2013-03
Volume
104
Issue
2
Pages
e159-e166
ISSN
  • 0008-4263 (ISSN-L)
  • 1920-7476
DOI
10.1007/bf03405681
PMC
PMC6973997
OpenAlex
W2114883385
Cited by
232
References
5
Citations by year
2026: 12 · 2025: 13 · 2024: 11 · 2023: 26 · 2022: 27 · 2021: 18 · 2020: 14 · 2019: 19 · 2018: 26 · 2017: 19 · 2016: 13 · 2015: 15 · 2014: 14 · 2013: 1
FWCI
1.68
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Canadian Journal of Public Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed
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
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
HPV self-testing, cervical cancer screening, screening uptake, screening adherence, Pap smear, underscreened women, self-collected samples, primary screening
MeSH terms
Uterine Cervical Neoplasms, Female, Humans, Patient Participation, Self Care, Specimen Handling, Randomized Controlled Trials as Topic, Papillomavirus Infections, Early Detection of Cancer

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