A recent article by Racey et. al., titled
“Self-collect HPV Testing Improves Participation in Cervical Cancer Screening:
A Systemic Review and Meta-analysis”1 addressed an often
challenging question of how to increase the effectiveness and reach of screening
programs.
In the case of cervical cancer, it is predominantly a disease of
low-income countries, with overall rates nearly twice as high in less developed
regions compared to more developed regions. In high income countries cervical
cancer screening is one of the most effective programs accounting for less than
15% of the global burden and 12% of deaths2. When one looks at the
WHO report on leading causes of deaths between the high and low income
countries, the vast majority of disease in both segments that can be addressed
by more effective screening and outreach to non-participants3.
With these statistics in mind, the findings
of this self-collection study could address several constraints that face
expansion of existing diagnostics programs.
Firstly, here are the key features of this study: [1] selection - identified
relevant articles that examined the use of HPV self-collected testing in never-
and under-screened women from publications between January 1, 1990 and July 15,
2012. This resulted in ten high quality studies between 2003 and 2010 that met
their inclusion criteria on design and compliance. These studies were restricted to developed
countries where Pap testing is the standard for cervical cancer screening with
the exception of Mexico, [2] design - accepted
control groups were those that offered a standard invitation to undergo Pap
testing at a local health care clinic or that offered Pap testing via the normal
procedures, [3] statistical analysis – the overall pooled relative compliance,
with 95% confidence intervals between the self-collected and control groups was
calculated using a random effects model so that each country was given equal
weighting.
Next are their findings: [1] the relative
compliance of HPV self-collected samples tested compared to Pap testing was
significantly greater than 1.0 in all ten studies, which support the paradigm
that women in this never- and under-screened segment were more likely to
participate in screening if they were offered HPV self-collection based
testing. The pooled compliance was 2.14 (95% CI 1.30-3.52), [2] the compliance
varied between 10.2% and 98.2% in the HPV arms and between 4.5% and 86.8% in
the Pap test arm, [3] all of the studies reported high specimen quality from
the self-collected samples for HPV testing.
The conclusion is clear and supports the
inclusion of self-collection as a viable method to increase cervical cancer
screening participation, particularly in those segments where disease morbidity
and mortality are highest. Although such
meta studies have inherent limitations because the studies are not designed
collectively, this study nevertheless is remarkably robust in its conclusion
that self-collection is an invaluable approach.
Together with the other body of data that validate the clinical
performance of self-collect molecular tests compared to traditional Pap, this study
does provide support for such an approach to be considered in managing other
leading causes of death in both the developed and developing countries where
self-collection is easy and safe for the patient. By enrolling patients in
screening programs that are designed to detect and treat disease earlier, the
cost savings to the respective health care systems could be compelling.
What do you think?
Join us for a webchat with Phil Castle to discuss current status and future trends in Cervical Cancer Screening, 19th November bit.ly/182ia9q
November 15th, 2013
Walter King, GE Healthcare Life Sciences
1.
Racey, C. Sarai, Withrow Diana
R., Gesink, Dionne, Canadian Journal of Public Health, March/April 2013:
e159-e166
2.
IARC/WHO - Globocan 2008 www.who.int/mediacentre/factsheets/fs310.pdf
3.
WHO Fact Sheet 2002, www.who.int/mediacentre/factsheets/fs310.pdf
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