HPV self-sampling as an alternative strategy in non-responders for cervical screening

Abstract

Background: In well-organised cervical cancer screening programmes in Europe and also in Slovenia, the majority of new cases of cervical cancer occur in those women who do not attend regular screening. Seeking new ways to increase coverage of the target population has thus become one of the key challenges. According to the findings of the meta-analyses, the best method is to invite the non-responders to perform vaginal self-sampling for the detection of high-risk human papillomavirus infection (HPV testing) at home. We were interested in the effectiveness of this approach in detecting pre-cancerous and early cancerous lesions of the cervix compared to the existing approaches.
Methods: A systematic review of the results of studies published in the field of HPV self-sampling within organised screening programmes in Europe.
Results: The two main results were the proportion of women who performed HPV self-sampling at home and the detection rate of the severe pre-cancerous lesions or cervical cancer. The additional results were the types of testers and methods of analyses used in the studies, quality of self-samples, prevalence of HPV among women who performed self-sampling, and participation of HPV-positive women in further diagnostics.
Conclusions: Alternative screening of non-responders by HPV self-sampling at home is currently the most promising approach to increase screening rates in order to enable further decrease of cervical cancer incidence in well organised cervical screening programmes. However, as the results differ between studies and countries, it is necessary to conduct a pilot study in an environment where regular screening takes place, before upgrading the existing screening programme.

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Povzetek

Ozadje in namen: V dobro organiziranih presejalnih programih raka materničnega vratu v Evropi in tudi Sloveniji se večina novih primerov raka materničnega vratu pojavlja pri tistih ženskah, ki se presejalnih pregledov ne udeležujejo redno. Iskanje novih načinov za povečanje pregledanosti ciljne populacije postaja zato eden vodilnih izzivov na tem področju. Po izsledkih preglednih raziskav in metaanaliz je najučinkovitejša metoda za povečanje odzivnosti vabilo neodzivnicam za samoodvzem vaginalnega vzorca za odkrivanje okužbe z visokotveganimi humanimi papilomskimi virusi (test HPV) na domu. Zanimalo nas je, kako učinkovita je ta metoda pri odkrivanju predrakavih in zgodnjih rakavih sprememb materničnega vratu v primerjavi z obstoječimi pristopi k neodzivnicam organiziranih presejalnih programov.
Metode: Sistematični pregled rezultatov objavljenih raziskav na področju presejanja neodzivnic rednih organiziranih presejalnih programov v Evropi, z metodo samoodvzema vaginalnega vzorca za test HPV na domu.
Rezultati: Glavna rezultata raziskav sta odzivnost žensk, ki so na dom prejele tester za samoodvzem, in delež odkritih hudih predrakavih sprememb ali raka materničnega vratu (CIN 2+). Dodatni rezultati so vrste v raziskavah uporabljenih testerjev in metod analize testov HPV, kakovost samoodvzetih vzorcev, prevalenca HPV v skupini žensk, ki so opravile samoodvzem vaginalnega vzorca, in udeležba v presejanju HPV-pozitivnih žensk v nadaljnji diagnostiki.
Zaključek: Številne raziskave enotno kažejo, da je za povečanje pregledanosti v dobro organiziranih presejalnih programih in nadaljnje zmanjšanje incidence raka materničnega vratu najbolj obetaven pristop alternativno presejanje neodzivnic s samoodvzemom vaginalnega vzorca za test HPV na domu. Ker pa se rezultati med raziskavami in državami razlikujejo, je treba pred nadgradnjo obstoječega presejalnega programa novo metodo pilotno preveriti v ciljni skupini neodzivnic programa v okolju, v katerem se izvaja redno presejanje.