HPV primary screening and abnormal screen follow-up

Clinician-collected versus patient-collected samples

Implementing HPV primary screening allows for screening participants to take their own samples and research suggests that test results from patient-collected samples are of comparable accuracy to clinician-collected samples in detecting moderately-severely abnormal cervical lesions.1

Australia restricts self-sampling to individuals who are under- or never-screened and requires screening participants to obtain a self-sampling kit and collect the sample in a clinical setting. In the Netherlands, self-sampling is only available to individuals who refuse a clinician-collected sample and in Finland, self-sampling is only available to individuals who are not participating in the organized screening program. The Netherlands and Finland each mail self-collection kits to eligible individuals and collection can be performed at home. Australia, the Netherlands, and Finland are each considering making self-sampling available to all eligible screening participants.

Benefits of patient-collected samples

The main benefits of self-sampling are:

  • Increased participation in cervical screening programs by under- and never-screened individuals
  • Better patient experience
  • Improved convenience for screening participants over clinician-collected samples

Strategies to combat common challenges with patient-collected samples

Self-sampling is not without challenges. These are described below, along with potential ways to overcome them.

Challenge with self-sampling Potential mitigation strategy
Low number of completed and returned self-sampling kits -Send an introductory letter offering individuals the choice to “opt-in” to receive a kit
-Educate individuals how to properly perform self-collection
-Use community campaigns to reach individuals eligible for self-collection
Cannot be used for cytology triage -Ensure screening participants opting for self-collection are connected to primary care for follow-up, including cytology
Privacy and packaging concerns with mailed kits -Package self-collection kits in plain packaging
-Keep addresses up-to-date in screening registry
Potential to be costly -Use an “opt-in” approach where participants request kits
Potential for over-screening -Establish a system that links the results for self-collected samples to the screening registry
Regulatory barriers -Advocate for commercial HPV assays to be validated for self-collection

Reference
1 – Polman, N. J. et al. Performance of human papillomavirus testing on self-collected versus clinician-collected samples for the detection of cervical intraepithelial neoplasia of grade 2 or worse: a randomised, paired screen-positive, non-inferiority trial. Lancet Oncol. 20, 229–238 (2019).

Previous: Abnormal screen results
Next: Test types