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Suitability of Self-Collected Vaginal Samples for Cervical Cancer Screening in Periurban Villages in Andhra Pradesh, India
Open accessAbstract
Objectives: Our aim was to determine if (1) Hybrid Capture 2 and a PCR-based method were comparable for detection of high-risk human papillomavirus (HPV) clinician-collected and self-collected samples were equally efficient to detect HPV and cervical cancer precursor lesions, and (3) if participation rates improved with home-based versus clinic-based self collection. Methods: Samples were selected from women participating in a cervical cancer screening study according to HPV, visual inspection with acetic acid, or Pap smear screening results. From 432 of 892 selected women, split sample aliquots were tested for HPV DNA using both the Hybrid Capture 2 assay and the Roche prototype line blot assay. Women from a subset of villages were recruited at two separate time points for clinic-based self-collection and home-based self-collection, and participation rates were compared. Results: Pairwise agreement between self- and clinician-collected samples was high by both Hybrid Capture 2 (90.8% agreement, κ = 0.7) and PCR (92.6% agreement, κ = 0.8), with significantly increased high-risk HPV detection in clinician-collected specimens (McNemar's P < 0.01). Ability to detect precursor lesions was highest by PCR testing of clinician-collected samples and lowest by Hybrid Capture 2 testing of self-collected samples (11 of 11 and 9 of 11 cases of cervical intraepithelial neoplasia grade 2/3 and cancer detected, respectively). Participation in home-based screening was significantly higher than clinic-based screening (71.5% and 53.8%, respectively; P < 0.001) among women ages 30 to 45 years. Conclusion: The combination of improved screening coverage and a high single test sensitivity afforded by HPV DNA testing of home-based self-collected swabs may have a greater programmatic effect on cervical cancer mortality reduction compared with programs requiring a pelvic exam. (Cancer Epidemiol Biomarkers Prev 2009;18(5):1373–8)
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The acceptability of HPV self-sampling has been shown to be very good among participating women.
“The acceptability of HPV self-sampling has been shown to be very good among participating women, the sample can be collected in their own private environment without having to visit the clinic or hospital, and self-sampling can also help women in overcoming multiple barriers [9-11].”
From Performance of HPV Self-Sample Collected by a Novel Kit in Comparison with Clinician Collected Sample for Cervical Cancer Screening (2024) · cites this paper as [11]
One study offered home-based self-collection following an initial round of facility-based screening, showing a greater response for home-based screening (58% vs 46%).
“One study offered home-based self-collection following an initial round of facility-based screening, showing a greater response for home-based screening (58% vs 46%),10”
Previous studies from India have demonstrated that home-based approaches are feasible and effective.
“Previous studies from India have demonstrated that home-based approaches are feasible and effective, as shown in studies from Andhra Pradesh, Tamil Nadu and West Bengal.10 46 47”
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Qiao, Y.-L., Sellors, J. W., Eder, P. S., Bao, Y.-P., Lim, J. M., Zhao, F.-H., Weigl, B., Zhang, W.-H., Peck, R. B., Li, L., et al. (2008) · The Lancet Oncology · doi:10.1016/s1470-2045(08)70210-9 · Cited by 471
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- Cuzick J, Arbyn M, Sankaranarayanan R, et al. Overview of human papillomavirus-based and other novel options for cervical cancer screening in developed and developing countries. Vaccine 2008;26:K29–41. · DOI
- Ogilvie GS, Patrick DM, Schulzer M, et al. Diagnostic accuracy of self collected vaginal specimens for human papillomavirus compared with clinician collected human papillomavirus specimens: a meta-analysis. Sex Transm Infect 2005;81:207–12. · DOI
- Petignat P, Faltin DL, Bruchim I, Tramer MR, Franco EL, Coutlee F. Are self-collected samples comparable with physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis. Gynecol Oncol 2007;105:530–5. · DOI · Paper page
- Winer RL, Feng Q, Hughes JP, et al. Concordance of self-collected and clinician-collected swab samples for detecting human papillomavirus DNA in women 18 to 32 years of age. Sex Transm Dis 2007;34:371–7. · DOI
- Jones HE, Allan BR, van de Wijgert JH, et al. Agreement between self- and clinician-collected specimen results for detection and typing of high-risk human papillomavirus in specimens from women in Gugulethu, South Africa. J Clin Microbiol 2007;45:1679–83. · DOI
- Safaeian M, Kiddugavu M, Gravitt PE, et al. Comparability of self-collected vaginal swabs and physician-collected cervical swabs for detection of human papillomavirus infections in Rakai, Uganda. Sex Transm Dis 2007;34:429–36. · DOI
- Gravitt PE, Peyton CL, Alessi TQ, et al. Improved amplification of genital human papillomaviruses. J Clin Microbiol 2000;38:357–61. · DOI · Paper page
- Gravitt PE, Peyton CL, Apple RJ, Wheeler CM. Genotyping of 27 human papillomavirus types by using L1 consensus PCR products by a single-hybridization, reverse line blot detection method. J Clin Microbiol 1998;36:3020–7. · DOI
- Castle PE, Solomon D, Wheeler CM, Gravitt PE, Wacholder S, Schiffman M. Human papillomavirus genotype specificity of hybrid capture 2. J Clin Microbiol 2008;46:2595–604. · DOI
- Goldie SJ, Kim JJ, Myers E. Chapter 19: Cost-effectiveness of cervical cancer screening. Vaccine 2006;24 Suppl 3:S164–70. · DOI · Paper page
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Racey, C. S., Withrow, D. R., & Gesink, D. (2013) · Canadian Journal of Public Health · doi:10.1007/bf03405681 · Cited by 232
Bansil, P., Wittet, S., Lim, J. L., Winkler, J. L., Paul, P., & Jeronimo, J. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-596 · Cited by 184
Self-citationCreagh, N. S., Boyd, L. A. P., Bavor, C., Zammit, C., Saunders, T., Oommen, A. M., Rankin, N. M., Brotherton, J. M. L., & Nightingale, C. E. (2023) · JCO Global Oncology · doi:10.1200/go.22.00297 · Cited by 17
Joshi, S., Kumar, B. K., Ramshankar, V., Maitra, N., Palit, S., Ravindran, S., & Shyam, T. (2024) · Asian Pacific Journal of Cancer Prevention · doi:10.31557/apjcp.2024.25.12.4211 · Cited by 2
Oommen, A. M., Ashfaq, M., Tonsing, M. V., Cherian, A. G., Singarayar, P., Viswanathan, V., Muniswamy, V., Hawkes, D., Abraham, P., Pricilla, R. A., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-101599 · Cited by 1
Metadata
- Authors
- Sowjanya, A. P., Paul, P., Vedantham, H., Ramakrishna, G., Vidyadhari, D., Vijayaraghavan, K., Laksmi, S., Sudula, M., Ronnett, B. M., Das, M., Shah, K. V., Gravitt, P. E., & on behalf of the Community Access to Cervical Health Study Group
- Affiliations
- Mediciti Institute of Medical Sciences (IN)
- Johns Hopkins University (US)
- Centre for DNA Fingerprinting and Diagnostics (IN)
- 1Center for DNA Fingerprinting and Diagnostics, Hyderabad, India;
- 2SHARE INDIA, Mediciti Institute for Medical Sciences, Ghanpur, India; and
- Venue
- Cancer Epidemiology, Biomarkers & Prevention
- Published
- 2009-05-01
- Volume
- 18
- Issue
- 5
- Pages
- 1373-1378
- ISSN
- 1055-9965 (ISSN-L)
- 1538-7755
- PMC
- PMC2762740
- OpenAlex
- W2136938075
- Cited by
- 60
- References
- 1
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 4 · 2014: 6 · 2013: 5 · 2012: 3
- FWCI
- 2.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cancer Epidemiology Biomarkers & Prevention (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (P50 CA98252, P50CA098252)
- 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
- cervical cancer screening, self-collected vaginal samples, Hybrid Capture 2, HPV testing, high-risk HPV, cervical intraepithelial neoplasia, home-based screening, screening rates, visual inspection with acetic acid, Andhra Pradesh
- MeSH terms
- Adult, Uterine Cervical Neoplasms, DNA, Viral, Female, Humans, India, Middle Aged, Self Care, Suburban Population, Vaginal Smears, Polymerase Chain Reaction, Papillomaviridae, Papillomavirus Infections, Early Detection of Cancer, Papanicolaou Test
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