Authors link universal HPV self-testing offer to higher cervical screening coverage in primary care

Evidence before this study

We did a literature search of MEDLINE (ProQuest) and Ovid databases from Jan 1, 1990, to Dec 31, 2020, for publications in English using terms: “human papillomavirus infections”, “HPV self-testing”, “self-sampling”, “self-collection”, and “HPV cervical cancer screening”. The published literature showed that human papillomavirus (HPV) testing by DNA-based PCR is the gold standard for primary cervical screening globally; HPV self-testing (ie, sample self-collection) using clinically validated PCR platforms is as sensitive at detecting disease as a clinician-taken cervical specimen; and offering HPV self-testing to under-screened and never-screened women increases screening uptake.

Added value of this study

Our study shows that a universal offer of HPV self-testing to all women and people with a cervix in a primary care clinic setting, due and overdue for cervical screening, achieves superior screening coverage compared with offering a cervical specimen by vaginal speculum examination. HPV self-testing reaches diverse and under-screened communities, enabling screening programmes to be more equitable and effective, thereby reducing the burden of preventable cervical cancer. These findings suggest that countries with organised cervical screening programmes should consider implementing a universal offer of HPV self-testing at a primary care level to increase screening coverage and reduce preventable morbidity and mortality from cervical cancer.

Implications of all the available evidence

Policy makers and clinicians working where national screening programmes use clinician-taken cervical sampling for either HPV testing or cytology testing should consider pivoting to a universal offer of HPV self-testing (which includes practice-level education, training, identification of key clinician champions, and ongoing educational support). This study made a real-time contribution to the implementation of the new New Zealand National Cervical Screening Programme and HPV self-testing has now been embedded in this screening programme for all eligible people. After the first year of screening, coverage has increased and HPV self-testing accounts for 80% of all screens in the programme. The universal implementation of HPV self-testing could make an important contribution to the equitable elimination of cervical cancer.

Source: The Lancet Obstetrics, Gynaecology, & Women’s Health