Compared with those gathered by a physician,
self-collected samples were about 11 percent less sensitive in
identifying precancerous growth.
However, the research team stops short of recommending at-home test
kits as a cancer screening method for women infected with the
sexually-transmitted human papillomavirus (HPV).
Some strains of HPV are directly linked to cervical cancer risk,
while others appear to have no negative effect on a woman's health.
"We want the current screening programs to continue to run," said
"We do not want to promote self-sampling procedures over doctor's
visits just yet," he said.
Arbyn, from the Unit of Cancer Epidemiology at the Scientific
Institute of Public Health in Brussels, is the review's lead author.
HPV tests, and not Pap smears, are "the new standard of cervical
cancer detection," Arbyn said.
In 2010, nearly 4,000 women in the U.S. died from cervical cancer,
according to the Centers for Disease Control and Prevention (CDC).
Meanwhile, a 2011 study found that 43 percent of girls and women
between ages 14 to 59 are infected with HPV.
Even though an HPV vaccine is available, the CDC reported that in
2012, only 33 percent of U.S. girls between 13 and 17 years old had
received the full, three-dose vaccination.
"Most cervical cancer cases reside in women who do not make regular
clinic visits," said Attila Lorincz of Queen Mary University in
London. Lorincz was not involved in the current study.
"It's unacceptable to have a status quo where a preventable cancer
continues to occur among women," Lorincz said.
In their analysis of 36 studies that included a total of 154,556
women, Arbyn and his team compared the accuracy of HPV tests taken
by women themselves and those collected by physicians.
On average, HPV tests from self-samples detected 76 percent of
moderate precancerous growth and 84 percent of severe cervical
"This study is a sort of challenge to health authorities," Lorincz
said. "It is a way of asking them, 'Are you doing all you can to
contact women by phoning or writing them?'"
"If not, then it may be time to consider self-sample tests," he
An editorial that accompanies the study published in Lancet Oncology
states, "For the billions already infected or without access to HPV
vaccination, improved screening for early detection and treatment
remain the best option for reducing cancer burdens."
[to top of second column]
Physicians should be aware of this new meta-analysis, Abryn said,
because "it is important to be able to know which are the best
combinations of tests and analyses."
But, he added, "We do not promote the ability of women to buy such
kits in a supermarket. We need an organized system behind HPV test
A large, randomized-control clinical trial — the gold standard of
evidence in medical studies — might provide additional reassurance
that HPV self-testing has a place in public health campaigns, much
like at-home sexually-transmitted disease kits for chlamydia do now,
The most important aspect of a self-test is its sensitivity, Lorincz
For example, if 100 women in a room have precancerous growth, and an
HPV test does not detect this growth in 10 women, then the
sensitivity rate is 90 percent.
If a test doesn't catch pre-cancerous cell growth, "then you have
lost your patient," Lorincz said.
"There are advances coming along in the consumer space that might
encourage women to be more open to HPV self-tests," Lorincz said.
"If they see a nicely designed tool, then they might think, 'Oh,
this looks nice, I would use this,'" he said.
Arbyn pointed to The Netherlands as a country that has already
decided to use self-sampling tests as a back-up to the preferred
method of a physician visit.
"Women receive invitations to contact their doctors for a cervical
cancer screening," Abryn said. "And the non-responders later receive
a self-sampling test."
"But it is difficult to translate messages from one country to
another," he said.
Oncology, online Jan. 14, 2014.
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