Self-Sampling for Cervical Cancer Screening Shows Promise

Most of us have heard of the pap smear, an annual test that is part of gynecological care for women, whose goal is early detection and prevention of cervical cancer. Have you ever considered collecting your own sample for testing in the comfort of your house?

One of the most exciting research findings unveiled at the recently concluded 20th World Congress of Obstetrics and Gynecology involves a field trial of cervical cancer screening using self-collected samples.

This study, involving 20,461 women from India, Nicaragua and Uganda, found that the sensitivity of a self-collected human papillomavirus (HPV)  sample (69.6 percent) was significantly better than the pap smear (58.4 percent), and almost equal to that of a health worker-collected cervical sample (81.5 percent), for detection of precancerous cervical lesions.

This is phenomenal news for women in resource-limited countries, who account for more than 80 percent of the 500,000 annual cases of cervical cancer, yet have little or no access to cervical cancer screening. Pap smear-based screening involves multiple provider visits, a trained pathologist and equipped laboratories — infrastructure that is only found in an established health system.

As a result, alternatives to the pap smear have been investigated for use in developing countries, such as the above study, which used careHPV, is a rapid molecular-based HPV test that can be run by a health care worker with minimal lab training in any setting — neither running water nor electricity is required. 

While it may not be suitable for San Francisco, the use of self-sampling for cervical cancer screening is exciting because many women in developing countries live far from established clinics and hospitals, are served by weak health systems with inadequate human resources and may have cultural barriers that preclude them from presenting for gynecological examinations.

If a self-collected sample can have results that are comparable to that of a health care worker-collected sample, cervical cancer screening in resource-limited communities can be performed at home, through outreach programs that can reach millions of women. This would begin to turn the tide of mortality from cervical cancer in developing countries, even as we await strengthening of health systems in these countries.

In opening the most recent Congress, held in Rome, the United Nations Population Fund Executive Director Dr. Babatunde Osotimehin noted that “women are still not all valued as they should be,” and called for greater adoption of a rights-based approach to addressing the challenges affecting women’s health globally. In addition to cervical cancer, other women’s health issues discussed included progress towards achieving Millennium Development Goals 4 and 5, targeted at reducing child mortality, improving maternal health and access to safe abortion, HIV prevention and obstetric fistula.

UCSF, whose Department of Obstetrics and Gynecology is highly involved in global women’s health, was well represented at this forum. Together with my presentation on access to cervical cancer treatment for HIV-infected women in Kenya, Dr. Okeoma Mmeje, a reproductive infectious disease fellow in the OB/GYN department, presented work on methods of safe conception among HIV discordant couples (one partner HIV-positive and the other HIV-negative) desiring pregnancy in Kenya.

UCSF also organized a panel discussion, led by Suellen Miller, PhD, on the role of an anti-shock garment in the management of hypovolemic shock in obstetric hemorrhage in resource-limited settings, including India, Egypt and Nigeria. More information on self-sampling and other exciting advances in global women’s health is available at FIGO2012.org.