Annals of Oncology 15:863-869, 2004
© 2004 European Society for Medical Oncology
Original Paper |
Primary cervical cancer screening by self-sampling of human papillomavirus DNA in internal medicine outpatient clinics
Received 21 August 2003; revised 25 January 2004; accepted 29 January 2004Background:
We determined whether testing of self-collected vaginal swabs for human papillomavirus (HPV) DNA can be used to screen for cervical disease within internal medicine outpatient clinics.
Patients and methods:
In this prospective study, 560 patients visiting two referral outpatient clinics for internal medicine were asked to take an HPV self-sample. Acceptability of self sampling, HPV prevalence and cervical intraepithelial neoplasia (CIN) detection rate were evaluated.
Results:
435 women (78%) performed HPV self-sampling; 1.5% considered self-sampling to be difficult. 134 women (31%) tested positive for high-risk type of HPV. There were significant differences between HPV-positive and -negative women with respect to the following: mean age (42 versus 46 years), number of women aged <16 years at first coitus (35% versus 23%) and history of drug abuse (8.3% versus 2.6%). Colposcopy could be performed for 70 HPV positive women: CIN 1–3 was identified in 24%. Two of 52 women with HPV-negative results undergoing colposcopy had biopsy-confirmed CIN 1. Test performance for detection of CIN 2–3 after correction for verification bias: sensitivity, 100%; specificity, 71%; negative predictive value, 100%; positive predictive value, 10%. HPV persistence was associated with a 5.7-fold risk of CIN 2–3 detection at follow-up.
Conclusions:
Self-assessment for HPV DNA is an easy, feasible and well-accepted method for HPV testing and for cervical cancer screening in internal medicine outpatient clinics.
1 Department of Obstetrics and Gynecology, University of Munich, Munich, Germany; 2 Harvard Center for Risk Analysis, Harvard School of Public Health, Boston, USA
Key words: cervical cancer screening, HPV, self-sampling
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