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Dyer CEF, Jin F, Hillman RJ, Nyitray AG, Roberts JM, Law C, Grulich AE, Poynten IM. Self-collected versus clinician-collected anal swabs for anal cancer screening: A systematic review and meta-analysis. Int J Cancer 2024. [PMID: 39140279 DOI: 10.1002/ijc.35133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/05/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024]
Abstract
Anal squamous cell carcinoma (ASCC) incidence is increasing globally. International consensus guidelines published in 2024 include HPV and/or cytology testing of anal swabs in those at greatest risk of ASCC. Self-collected anal swabs may be important for increasing screening uptake, but evidence is needed as to their equivalence to clinician-collected swabs. We searched Medline, Embase, Cochrane Library, and CINAHL databases for publications to 13 June 2023. Studies were included if reporting data on HPV testing, cytology testing, or acceptability, for both self- and clinician-collected anal swabs. Risk of bias was assessed using the QUADAS-2 assessment tool. The primary outcome was HPV and cytology sampling adequacy. Secondary outcomes were HPV and cytology results, and acceptability of collection methods. Thirteen papers describing 10 studies were eligible. Sample adequacy was comparable between self- and clinician-collected swabs for HPV testing (meta-adequacy ratio: 1.01 [95% CI 0.97-1.05]) but slightly lower for cytology by self-collection (meta-adequacy ratio: 0.91 [95% CI 0.88-0.95]). There was no significant difference in prevalence (meta-prevalence ratio: 0.83 (95% CI 0.65-1.07) for any HR-HPV, 0.98 (95% CI 0.84-1.14) for any HPV, and 0.68 (95% CI 0.33-1.37) for HPV16), or any cytological abnormality (meta-prevalence ratio 1.01 [95% CI 0.86-1.18]). Only three papers reported acceptability results. Findings indicate self-collection gives equivalent sample adequacy for HPV testing and ~ 10% inferior adequacy for cytological testing. Meta-prevalence was similar for HPV and cytology, but confidence intervals were wide. Larger studies are required to definitively assess use of self-collected swabs in anal cancer screening programs, including acceptability.
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Affiliation(s)
- Clare E F Dyer
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Richard J Hillman
- Kirby Institute, UNSW Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Carmella Law
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - I Mary Poynten
- Kirby Institute, UNSW Sydney, New South Wales, Australia
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2
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McGill F, Fields PJ, Bahadoor-Yetman A, Manglardi ES, Bailey R, Padala K, Lendore J, John-Ballantyne T, Lake S. Investigating under-reported human papillomavirus genotypes in Grenadian women through self-sampling for cervical cancer screening. Rev Panam Salud Publica 2024; 48:e62. [PMID: 39044773 PMCID: PMC11265311 DOI: 10.26633/rpsp.2024.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/22/2024] [Indexed: 07/25/2024] Open
Abstract
Objective To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.
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Affiliation(s)
- Frances McGill
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
| | - Paul J. Fields
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
| | - Aví Bahadoor-Yetman
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
| | - Erin Salter Manglardi
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
| | - Ronelle Bailey
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
| | - Kritika Padala
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
| | - Jessica Lendore
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
| | | | - Sasha Lake
- St. George’s UniversitySt. George’sGrenadaSt. George’s University, St. George’s, Grenada
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Huguet N, Danna M, Baron A, Hall J, Hodes T, O’Malley J, Holderness H, Marino M, DeVoe JE, Cohen DJ. Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers: Practice Changes and Recovery Strategies. Med Care 2023; 61:554-561. [PMID: 37310241 PMCID: PMC10319245 DOI: 10.1097/mlr.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic led to clinical practice changes, which affected cancer preventive care delivery. OBJECTIVES To investigate the impact of the coronavirus disease 2019 pandemic on the delivery of colorectal cancer (CRC) and cervical cancer (CVC) screenings. RESEARCH DESIGN Parallel mixed methods design using electronic health record data (extracted between January 2019 and July 2021). Study results focused on 3 pandemic-related periods: March-May 2020, June-October 2020, and November 2020-September 2021. SUBJECTS Two hundred seventeen community health centers located in 13 states and 29 semistructured interviews from 13 community health centers. MEASURES Monthly up-to-date CRC and CVC screening rates and monthly rates of completed colonoscopies, fecal immunochemical test (FIT)/fecal occult blood test (FOBT) procedures, Papanicolaou tests among age and sex-eligible patients. Analysis used generalized estimating equations Poisson modeling. Qualitative analysts developed case summaries and created a cross-case data display for comparison. RESULTS The results showed a reduction of 75% for colonoscopy [rate ratio (RR) = 0.250, 95% CI: 0.224-0.279], 78% for FIT/FOBT (RR = 0.218, 95% CI: 0.208-0.230), and 87% for Papanicolaou (RR = 0.130, 95% CI: 0.125-0.136) rates after the start of the pandemic. During this early pandemic period, CRC screening was impacted by hospitals halting services. Clinic staff moved toward FIT/FOBT screenings. CVC screening was impacted by guidelines encouraging pausing CVC screening, patient reluctance, and concerns about exposure. During the recovery period, leadership-driven preventive care prioritization and quality improvement capacity influenced CRC and CVC screening maintenance and recovery. CONCLUSIONS Efforts supporting quality improvement capacity could be key actionable elements for these health centers to endure major disruptions to their care delivery system and to drive rapid recovery.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Maria Danna
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Andrea Baron
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Jennifer Hall
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Tahlia Hodes
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | | | - Heather Holderness
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Deborah J. Cohen
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
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Validity and acceptance of self vs conventional sampling for the analysis of human papillomavirus and Pap smear. Sci Rep 2023; 13:2809. [PMID: 36797261 PMCID: PMC9933799 DOI: 10.1038/s41598-023-29255-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
The newest high-risk human papillomavirus (HPV) detection techniques were included for cervical cancer primary screening under the Spanish National Health System in 2019. These analyses allow changing population approaches to foster adherence to screening. Therefore, the validity of self versus conventional sampling for HPV and cytology analyses was appraised. Women's preferences concerning samples and devices were also evaluated. This is a diagnostic accuracy cross-sectional study among 120 women recruited from a colposcopy clinic at a general hospital in Illes Balears, Spain. Participants were given written information and asked for a self-sample. One of two sets containing two devices each were handed. One set was transported dry and the second in liquid medium. Next, clinicians collected vaginal samples that were our gold standards. The agreement between both techniques was examined with the Kappa coefficient (κ). Self-sampling evaluation and preferences for different vaginal devices were also surveyed. The agreement between self and conventional samples concerning HPV positivity was very good (κ 0.86 for Mía by XytoTest® and 0.83 for Viba-Brush®) or reasonable (κ 0.73 for Iune and 0.68 for viscose swab). Pap smears from self-samples exhibited moderate agreement (κ 0.41 for Mía® and 0.51 for Viba-Brush® respectively) for negative versus ASC-US and worse results. Most of the participants considered self-sampling as beneficial (110 or 91.7%) and the advantages were, in decreasing order, scheduling, comfort, intimacy and less fear for pain or disturbance. The priority of choice for the devices was Mía® and viscose swab (chosen in first or second place) in opposition to Iune and Viba-Brush® (chosen in third or fourth place). If Viba-Brush® was to collect the best quality samples, 108 women (94.7%) switched their decisions. Our agreement between self and conventional samples was very good or reasonable for HPV, with the best values for devices in a liquid medium, and moderate for cytology. Even so, reflex cytology on self-samples is a valuable tool in promoting adherence. Self-sampling was widely accepted for smooth and thin devices. However, there is no resistance to change to others if a higher quality of the sample is obtained.
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Isabirye A, Elwange BC, Singh K, De Allegri M. Individual and community-level determinants of cervical cancer screening in Zimbabwe: a multi-level analyses of a nationwide survey. BMC Womens Health 2022; 22:309. [PMID: 35879710 PMCID: PMC9310401 DOI: 10.1186/s12905-022-01881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the benefits of cervical cancer (CC) screening to reduce the disease burden, uptake remains limited in developing countries. This study aims to assess the individual and community-level determinants of cervical cancer screening among women of reproductive age in Zimbabwe. METHODS We analyzed data collected from 400 communities from the 2015 Zimbabwe Demographic and Health Survey with a sample size of 9955 women aged 15-49 years. The descriptive statistics and multi-level regression models adjusted for potential covariates were performed to examine the association between individual, household and community-level factors and the uptake of cervical cancer screening in women. RESULTS The mean (SD) age of women in Zimbabwe using cervical cancer screening was 27.9 (9.9) years. A relatively small proportion of women, i.e., only 13.4% had ever screened for cervical cancer, with higher screening rates observed in the following sub-groups: middle aged women 31-49 years (odds ratio (OR) = 2.01; 95% confidence intervals (CI) 1.72-2.34), and currently working (OR = 1.35; 95% CI 1.17-1.55), those with health insurance (OR = 1.95; 95% CI 1.63-2.34), used modern contraceptives (OR = 1.51; 95% CI 1.22-1.86), exposed to multiple media (OR = 1.27; 95% CI 1.03-1.58), those living in communities that had a high predominance of women with favorable attitude towards Intimate Partner Violence (IPV) against women (OR = 1.21; 95% CI 1.04-1.41) and a non-poor wealth index (OR = 1.54; 95% CI 1.14-2.05). CONCLUSIONS Our data shows a significantly low prevalence of cervical cancer screening among reproductive age women in Zimbabwe. To increase the uptake of cervical cancer screening, there is an urgent need both to implement behavioral interventions targeted at women from low socio-economic groups and to advocate for universal health coverage that includes financial risk protection to help all women realize their right to health.
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Affiliation(s)
- Alone Isabirye
- Department of Sociology, Anthropology, and Population Studies (Demography), Faculty of Social Sciences, Kyambogo University, Kampala, Uganda.
| | - Bob Charlestine Elwange
- Department of Sociology, Anthropology, and Population Studies (Demography), Faculty of Social Sciences, Kyambogo University, Kampala, Uganda
| | - Kavita Singh
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Public Health Foundation of India, New Delhi, India
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Abstract
BACKGROUND An increased incidence in hygiene-related urogenital infections (bacterial vaginitis, vulvovaginal candidiasis, and urinary tract) has been reported in female warfighters serving in austere environments with decreased availability of water and sanitation resources, and when personal safety outweighs concerns for hygiene. Knowledge and access to an innovative kit designed for the female warfighter to self-test, self-identify, and self-treat common urogenital symptoms is critical to force health. PURPOSE The purpose of this descriptive, cross-sectional, exploratory qualitative study was to explore female warfighters': 1) confidence in seeking sex-specific health care in field and deployment environments and 2) acceptance and willingness to self-test, self-identify, and self-treat urogenital symptoms and infections. METHODOLOGICAL ORIENTATION Qualitative data for this thematic analysis were collected during administration of the Military Women's Readiness Urogenital Health Questionnaire. Participants provided open-ended comments associated with three survey questions. Braun and Clarke's inductive thematic analysis method guided the narrative analysis. SAMPLE Our sample included a diverse group of US Army women (USAW; n = 152) from a large, military installation. RESULTS Narratives and themes demonstrate USAW's desire and need for the availability of a self-test and self-treatment kit. Access, time, mission, and prevention of self-harm by quicker resolve of symptoms are cited as key reasons in support of such a kit. CONCLUSIONS AND PRACTICE IMPLICATIONS Nurse practitioners (NPs) are ideally positioned to provide sex-specific educational interventions and anticipatory guidance that supports physical health, to include urogenital conditions. As urogenital self-testing becomes available for female warfighters, NPs are the model healthcare provider for educating women on their use.
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Loopik DL, Melchers W, Vedder J, van den Brule A, Massuger L, Bekkers R, Siebers AG. Reflex cytology for triage of high-risk human papillomavirus positive self-sampled material in cervical cancer screening: a prospective cohort study. BJOG 2020; 127:1656-1663. [PMID: 32506627 PMCID: PMC7689810 DOI: 10.1111/1471-0528.16352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE High-risk human papillomavirus (HrHPV)-positive women detected by self-sampling require an extra visit at the general practitioner for additional cytology testing, but the loss to follow up within this triage is substantial. The aim of this study was to evaluate the clinical utility of reflex cytology on hrHPV-positive self-samples for immediate stratification of women who need referral for colposcopy. DESIGN A prospective cohort study. SETTING Two Dutch cervical cancer-screening laboratories. POPULATION 1014 screenees who tested hrHPV-positive on self-samples between 1 December 2018 and 1 August 2019. METHODS Self-samples were directly used for cytological analysis. Cytological and histological outcomes during follow up were obtained from the Dutch Pathology Registry (PALGA). MAIN OUTCOME MEASURES Test performance of reflex cytology on self-samples was determined for different thresholds and compared with physician-taken cytology and histological outcomes. RESULTS Reflex cytology on self-samples for detecting abnormal cytology showed a sensitivity of 26.4% (95% CI 21.8-31.3) and specificity of 90.5% (95% CI 87.7-92.8). Of all ≥CIN2 cases, 29.4% (95% CI 22.5-37.1) were detected with reflex cytology on self-samples. The positive predictive value for detection of ≥CIN2 was higher with cytology on self-collected samples than on physician-collected samples. Of women who were lost to follow up, 12.9% were found to have abnormal cytology on their self-sampled material. CONCLUSION Cytology testing is achievable on hrHPV-positive self-samples, could decrease the loss to follow up in screening and is easily implementable in the current clinical practice. Of all hrHPV-positive women with abnormal cytology on additional physician-collected samples, 26.4% could have been directly referred for colposcopy if triage with reflex cytology on self-sampled material had been performed. TWEETABLE ABSTRACT Reflex cytology for triage of hrHPV+ self-samples is of added value for direct referral of women for colposcopy.
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Affiliation(s)
- D L Loopik
- Department of Obstetrics and Gynaecology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Wjg Melchers
- Department of Medical Microbiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Jem Vedder
- Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands
| | - Ajc van den Brule
- Department of Pathology, Lab for Molecular Diagnostics, Pathologie-DNA, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Lfag Massuger
- Department of Obstetrics and Gynaecology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rlm Bekkers
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - A G Siebers
- Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands.,PALGA, the Nationwide Network and Registry of Histo- and Cytopathology, Houten, The Netherlands
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