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Women averse to traditional screening could avoid invasive cervical cancer with an alternative method to test for high risk human papillomavirus (HR-HPV) in lavage samples they can collect themselves. This could drive down the 50% rate of invasive cervical cancer in women who are not currently screened.
A prospective study compared lavage samples collected by a doctor and by women at home with a standard Papanicolaou (Pap) smear. It found good agreement for detecting HR-HPV (93% and 78%, respectively) but unacceptably low agreement for cytological results. However, there was sufficient agreement between high grade cervical intraepithelial neoplasia and HR-HPV results from the lavage samples taken by the doctor (91%) and the women (81%) and from the smear (91%) to indicate that samples collected by women are suitable for screening. A brief questionnaire showed that most women preferred self collection over the smear test.
Seventy one women from two colposcopy clinics collected a cervicovaginal lavage sample at home and had another taken by a doctor in the clinic, followed by a standard Pap smear test and then colposcopy. Fifty six women had mild dyskaryosis or worse and 15 had normal results. Each sample/smear was tested for cytological signs of cervical cancer and evidence of HPV infection by PCR immunoassay.
Cervical cancer is treatable if diagnosed early, but many women fail to attend for a smear test. Testing lavage samples for HR-HPV is a feasible alternative. Nevertheless, “participation in the [traditional] screening programme remains the best option,” say the researchers.
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