Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses
- Study type
- Meta-analysis
- Design
- Updated systematic review and meta-analysis (including a diagnostic accuracy review and a screening participation review)
- Sample size
- 56 diagnostic accuracy studies and 25 participation trials
- Source
- BMJ · 2018
In plain words
This research brought together the results of many studies to see whether women can take their own sample for an HPV test. When PCR-based tests are used, a sample a woman takes herself finds cervical precancer almost as well as a sample taken by a clinician. Sending a sampling kit to women's homes brings in more women who have been screened too little than an invitation letter does. However, results differ between settings.
Key results
Treatment arms and regimens
hrHPV testing on a self-collected vaginal sample, compared with hrHPV testing on a clinician-collected sample.
Women were invited to collect a self-sample for hrHPV testing.
Women were invited or reminded to have a screening test on a clinician-collected sample. Participation was recorded in both groups.
Source of the regimen details: Abstract of the paper (systematic review of a screening test; no drug intervention)
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Diagnostic accuracy review: studies in which high-risk HPV (hrHPV) testing was done on a self-collected vaginal sample and a clinician-collected sample, and the presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was verified by colposcopy and biopsy in all enrolled women or in women with a positive test.
Participation review: the study population consisted of women who had been screened irregularly or never, with a minimum population of 400 women.
Endpoints
Assessment of the diagnostic accuracy of hrHPV tests on self-collected samples (sensitivity and specificity for detecting CIN2+ or CIN3+) and the effectiveness of self-sampling strategies in reaching underscreened women (participation rate).
Safety and side effects
No adverse-event data are reported in the abstract.
Clinical significance and place in guidelines
According to the abstract, self-sampling with PCR-based hrHPV tests is a screening option with accuracy similar to clinician sampling and can be used to reach underscreened women; signal amplification-based tests had lower sensitivity. The authors recommend pilot programmes before wide implementation. The status of this approach in current guidelines and regulatory approvals should be checked separately and is not reported in the abstract.
Limitations
Very high heterogeneity between studies (I² above 95%) and wide variability in response rates across settings are reported. Accuracy results depend on the type of test (PCR versus signal amplification). Other limitations should be checked in the full text of the paper.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.