SELF-SAMPLING CAN IMPROVE OUTCOMES BY REDUCING BARRIERS TO SCREENING
Evidence has demonstrated that infections from high-risk strains of HPV can lead to cervical cancer later in life.1,2 In 2016, 1500 new cases of cervical cancer were predicted in Canada, with 400 women expected to die from this disease.3 Early diagnosis and treatment is key in reducing the incidence and prevalence of cervical cancer.4 Widespread cervical cancer screening programs have dramatically reduced cervical cancer incidence rates and deaths. Unfortunately, about 30% of Canadian women are still not receiving regular screening.3,5,6 Low income women, immigrant women, indigenous women and women living in remote communities are less likely to receive screening, putting them at a higher risk of advanced cervical cancer and poor health outcomes.7-9
Since the late 1990s, sexually transmitted infection (STIs) rates have been steadily increasing in Canada, despite the implementation of widespread and targeted public health programs.1,10 This is of great concern, especially in women, as chlamydia is the most commonly reported bacterial STI in Canada and majority of the cases are asymptomatic. Additionally, there is some evidence that recent changes to cervical screening guidelines may reduce rates of chlamydia screening, especially in younger women at high risk.2 Bacterial STIs, such as chlamydia or gonorrhea, can lead to pelvic inflammatory disease, infertility, or other complications during pregnancy if they’re left untreated.11
Lower levels of screening have been attributed to a number of barriers, such as lack of knowledge and awareness about STIs, embarrassment and inconvenience, not having a family doctor, and religious, cultural and language barriers.8,9,12-15 Innovative interventions such as self-sampling either at home or in a clinic, have demonstrated improved uptakes rates for testing and screening of HPV and STIs. 10,13,16,17 Women view self-sampling as an acceptable and practical alternative to physician collected samples,15 and studies have shown it to be comparable in sample quality to physician collected samples. 18
1. Self-collected versus clinician collected samples for sexually transmitted infection testing in women: a review of comparative clinical effectiveness cost-effectiveness, and guidelines [Internet]. Ottawa (ON): CADTH; 2016 Jun 22. (CADTH rapid response reports). Available from: https://www.cadth.ca/sites/default/files/pdf/htis/june-2016/RC0787%20Self%20vs%20Clinician%20Collected%20Samples%20Final.pdf
2. Ursu A, Sen A, Ruffin M. Impact of cervical cancer screening guidelines on screening for chlamydia. Ann Fam Med [Internet]. 2015 Jul [cited 2017 Jan 11];13(4):361-3. Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508178
3. Canadian cancer statistics. Special topic: HPV-associated cancers [Internet].Statistics Canada; 2016 Oct. Available from:http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2016-EN.pdf?la=en
4. Fajardo-Bernal L, Aponte-Gonzalez J, Vigil P, Angel-Müller E, Rincon C, Gaitán HG, et al. Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections. Cochrane Database Syst Rev. 2015;9:CD011317.
5. Canadian Task Force on Preventive Health Care, Dickinson J, Tsakonas E, Conner GS, Lewin G, Shaw E, et al. Recommendations on screening for cervical cancer. CMAJ [Internet]. 2013 Jan 8 ;185(1):35-45. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3537778
6. Lofters A, Vahabi M. Self-sampling for HPV to enhance uptake of cervical cancer screening: Has the time come in Canada? CMAJ. 2016 Apr 25.
7. Tota JE, Bentley J, Blake J, Coutl‚e F, Duggan MA, Ferenczy A, et al. Introduction of molecular HPV testing as the primary technology in cervical cancer screening: acting on evidence to change the current paradigm [Internet]. Ottawa: Canadian Cancer Survivor Network; 2015 Dec 9. (Evidence review and report). Available from:http://survivornet.ca/uploads/files/Executive%20Summary%20-%20report%20on%20primary%20HPV%20screening-F2.pdf
8. New and emerging technologies for self-sampling for cervical cancer screening (HPV) [Internet]. Birmingham (UK): University of Birmingham; 2014 Mar. Available from:http://www.hsric.nihr.ac.uk/topics/new-and-emerging-technologies-for-self-sampling-for-cervical-cancer-screening-hpv-review/
9. Vahabi M, and Lofters A. Mulism immigrant women’s view on cervical cancer screening and HPV self-sampling in Ontario, Canada. Bmc Public Health. 2016;16:868
10. Lunny C, Taylor D, Hoang L, Wong T, Gilbert M, Lester R, et al. Self-collected versus clinician-collected sampling for chlamydia and gonorrhea screening: a systemic review and meta-analysis. PLoS One [Internet].2015 ;10(7):e0132776. Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500554
11. Aldeen T, Jacob, J and Powell R. Screening university students for genital chlamydial infection:another lesson to learn. Sexual Health. 2010; 7: 491-494
12. Sultana F, Mullins R, English DR, Simpson JA, Drennan KT, Heley S, et al. Women’s experience with home-based self-sampling for human papillomavirus testing. BMC Cancer [Internet]. 2015 ;15:849. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634718
13. Racey CS, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical cancer screening: a systematic review and meta-analysis. Can J Public Health. 2013 Mar;104(2):e159-e166.
14. 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 [Internet]. 2011 Mar 15 ;104(6):915-20. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065284
15. Paudyal P, Llewellyn C, Lau J, Mahmud M, Smith H. Obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review of patients’ experiences. PLoS One [Internet]. 2015 ;10(4):e0124310. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409059
16. Sarai Racey C, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical cancer screening: A systematic review and meta-analysis. Can J Public Health [Internet]. 2013 ;104(2):e159-e166. Available from: http://journal.cpha.ca/index.php/cjph/article/viewFile/3776/2765
17. Verdoodt F, Jentschke M, Hillemanns P, Racey CS, Snijders PJ, Arbyn M. Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer. 2015 Nov;51(16):2375-85.
18. Arbyn M, Verdoodt F, Snijders PJ, Verhoef VM, Suonio E, Dillner L, Minozzi S, Bellisario C, Banzi R, Zhao FH, Hillemanns P, Anttila A. Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis. Lancet Oncol. 2014 Feb;15(2):172-83.
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