HPV self-testing again shows potential screening value

Another study has shown that human papillomavirus (HPV) testing of self-collected cervicovaginal specimens may be an effective way to screen more women for cervical cancer.

Last fall, a team led by Professor Attila T. Lorincz, PhD, of the Centre for Cancer Prevention at Queen Mary University in London, United Kingdom, reported in The Lancet favorable results of HPV self-testing among women of low socioeconomic status in underserved areas of Mexico (https://www.oncologynurseadvisor.com/home/headlines/web-exclusives/self-testing-for-hpv-may-increase-screening-rates/). Now, You-Lin Qiao, MD, PhD, of the Cancer Institute and Hospital at the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, People’s Republic of China, and colleagues have announced similar findings in Journal of the National Cancer Institute (2012; 104:1-11; http://jnci.oxfordjournals.org/content/early/2012/01/23/jnci.djr532.full.pdf+html).

Qiao’s group analyzed data from 13,004 women participating in five population-based cervical cancer screening studies in China. The women underwent HPV self-testing of self-collected Pap specimens, physician-collected cervical specimens for HPV testing, liquid-based cytology (LBC), and visual inspection with acetic acid (VIA).

A total of 507 women (3.9%) were diagnosed with cervical intraepithelial neoplasia grade 2 or more severe (CIN2+), 273 (2.1%) with CIN3+, and 37 (0.3%) with cervical cancer. HPV self-testing demonstrated 86.2% sensitivity and 80.7% specificity for detecting CIN2+, and 86.1% sensitivity and  79.5% specificity for detecting CIN3+.

HPV testing of self-collected Pap specimens was more sensitive and less specific than LBC and VIA, but less sensitive and similarly specific than physician-collected Pap specimens:

• Physician HPV testing was more sensitive for detecting CIN2+ (97.0%) and CIN3+ (97.8%), but similarly specific for detecting CIN2+ (82.7%) and CIN3+ (81.3%).
• LBC had lower sensitivity for detecting CIN2+ (80.7%), similar sensitivity for detecting CIN3+ (89.0%), and higher specificity for detecting CIN2+ (94.0%) and CIN3+ (97.8%).
• VIA sensitivity was statistically significantly lower for detecting CIN2+ (50.3%) and CIN3+ (55.7%), but specificity was higher (87.4% for CIN2+ and 86.9% for CIN3+).

The researchers concluded that although HPV self-testing is not specific enough to be a stand-alone test, it does provide sensitive results without pelvic exams, medical professionals, or health care facilities, and thus has the potential to serve as a primary cervical cancer screening method for women, regardless of their geographic location or access to health care. However, the investigators cautioned that self-sampling procedures were instructed by medical professionals, and that it is unclear whether unsupervised self-exams would yield similar outcomes.