Assessment of HPV screening modalities within primary care: a systematic review

TL;DR

This study reviews evidence showing that HPV self-sampling is as effective as clinician-collected samples for cervical cancer screening and is preferred by many patients due to comfort and privacy.

Contribution

The study provides a systematic review showing HPV self-sampling is a viable, patient-preferred alternative to clinician-collected sampling.

Findings

HPV self-sampling is comparable to clinician-collected samples in detection rates and sensitivity.

64.3% of individuals favored self-sampling due to increased comfort and privacy.

Self-sampling is an effective and cost-efficient alternative, especially for under-screened populations.

Abstract

Most cervical cancer precancerous lesions are associated with high-risk human papillomavirus (HPV) subtypes. Early detection through screening is crucial for preventing and managing HPV-related diseases. HPV Self-sample screening is a proposed method that can mitigate socioeconomic disparities, reduce embarrassment and costs of screening. This can possibly reduce the overall disease burden.

A search strategy was conducted across multiple databases, including PubMed, Cochrane Library, Scopus, and Embase. Data extraction was performed using a standardized form to collect detailed information on study characteristics, participant demographics, and various outcomes. The quality and risk of bias in the articles were assessed using the Critical Appraisal skills programme (CASP) checklist, and the Cochrane Risk of Bias (ROB) tool.

Our review consistently found that HPV self-sampling is comparable to clinician-collected samples in terms of HPV detection rates and sensitivity, supporting the idea that HPV self-sampling can be a viable alternative for cervical cancer screening. Across the studies, self-sampling showed comparable or greater effectiveness to clinician-collected samples in detecting HPV in individuals. Specificity was comparable between both methods, with clinician-collected sampling slightly outperforming HPV self-sampling in some cases. Moreover when analyzing the negative predictive value (NPV) and positive predictive value (PPV) across the studies, it was evident that there was little difference between clinician-collected sampling and HPV self-sampling. 64.3% favored self-sampling over clinician-collected sampling due to increased comfort and privacy. Overall, the evidence suggests that self-sampling is an effective, patient-preferred, and cost-efficient alternative to clinician-collected sampling, particularly in under-screened populations.

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