Secondary Prevention of HPV
Screening for cervical cancer involves checking the cervix or cervical samples for signs of cervical cancer before it develops. In most high income countries, cervical cancer screening is performed using pap testing (also called cytology) which detects cervical lesions through a pelvic exam. Cytology was introduced in the 1940s, and countries where screening has been implemented have enjoyed massive reductions in cervical cancer rates. However, cytology programs are resource intensive and cannot be realistically implemented in many low-resource settings. Furthermore, there are newer screening tests that are better at detecting cervical cancer than cytology. Specifically, many countries are exploring HPV testing, which involves laboratory testing on vaginal samples for high risk strains of the HPV virus DNA. Samples can be collected by clinicians, or by women themselves (self-collection) using a swab or brush device.
Using self-collected samples for HPV testing
Some women, particularly those in low-resource settings, face personal, logistical, and health care systems barriers to clinic-based screening. Some of these barriers can be addressed with self-collection based cervical cancer screening including:
Privacy & cultural concerns about receiving a pelvic exam: Self-collection is performed by the woman herself using a small, non-invasive swab.
Time and distance to travel: A sampling device can be sent to women at their homes, either by mail or using community health workers, eliminating the need to accommodate clinic hours.
Health care system limitations: Cytology is performed by specialised practitioners which can be in short supply in many settings. HPV testing is performed at a laboratory, reducing the burden on overstretched healthcare systems.
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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;104(2):e159-66.