In Kenya, women face a cervical cancer mortality rate that is approximately 10 times as high as in the United States. A study by researchers at the University of North Carolina at Chapel Hill suggests that training women to self-collect genital samples to test for human papillomavirus (HPV), the causative agent of cervical cancer, can increase the coverage rates of cervical cancer screening. Higher screening coverage helps increase rates of detection of cervical lesions and ultimately treatment of the disease.
“The high mortality rate in Kenya is most likely attributable to a lack of cervical cancer screening and early treatment programs, as well as relatively high HIV prevalence. More concerted efforts need to be made to reduce cervical cancer, which is highly preventable,” said Jennifer Smith, PhD, MPH, research associate professor at the UNC Gillings School of Global Public Health and member of the UNC Lineberger Comprehensive Cancer Center.
The study, published online by the journal Sexually Transmitted Diseases, collected data from 350 female sex workers in the Korogocho slum area of Nairobi from August 2009 to March 2011. Due to high HPV and HIV prevalence, these women have a higher risk of cervical cancer and associated high grade lesions than the general population. Recruited by community peer leaders at public meetings, participants attending the study clinic were first instructed to self-collect genital specimens for HPV testing using a brush provided by the study.
The self-collection was followed-up with a pelvic examination, where a physician collected cervical samples for Pap smear and HPV testing. The Pap smears were independently evaluated by two cytopathologists from the University of Nairobi, with discrepancies reviewed by a third. The HPV testing results showed strong agreement between the samples collected by the physician and those collected by the women themselves.
“In our study in Nairobi, women were able to follow the self-collection instructions, and the specimens collected by the women were of high quality. We compared physician- and self-collected samples for HPV testing, and our results show that HPV testing of the two sample types performed equally well in detecting high-grade lesions. These findings indicate that self-collection for HPV testing may be a viable means to increase cervical cancer screening coverage in low-resource regions,” said the study’s lead author Jie Ting, PhD, postdoctoral fellow in epidemiology at UNC.
HPV testing is effective in early detection of cervical pre-cancerous and cancerous tumors and is currently recommended for co-testing with Pap smear for women aged 30 years or older in the United States. In traditional clinical settings, collection of cervical specimens for HPV testing is performed by a physician.
Cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow-up. Two screening tests can help prevent cervical cancer or find it early—
The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.
The Pap test is recommended for all women between the ages of 21 and 65 years old, and can be done in a doctor’s office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory. The laboratory will check to be sure that the cells are normal.
If you are getting the HPV test in addition to the Pap test, the cells collected during the Pap test will be tested for HPV at the laboratory. Talk with your doctor, nurse, or other health care professional about whether the HPV test is right for you.
When you have a Pap test, the doctor may also perform a pelvic exam, checking your uterus, ovaries, and other organs to make sure there are no problems. There are times when your doctor may perform a pelvic exam without giving you a Pap test. Ask your doctor which tests you are having, if you are unsure.
“What will also be interesting is to look at how self-collection will work in a setting other than a clinical one. For example, if the women were to perform self-collection at home, how would that to compare to when she does it in the clinic?” said Ting.
Each year, approximately 12,000 women in the U.S. get cervical cancer. As the second most common cause of cancer deaths in women, cervical cancer has an impact on females around the world.
Dr. Laurie Zephyrin, the national director of Reproductive Health at the Department of Veteran Affairs, says making screenings part of a woman’s regular physical can save lives.
For her, the goal to increased and early detection is simple and clear.
“It’s about ensuring access to high quality care and educating women on how to take care of themselves.”
University of North Carolina Health Care