Cervical cancer screening using HPV tests on self-samples: attitudes and preferences of women participating in the VALHUDES study

Abstract

Background: Interventions to reach women who do not participate regularly in screening may reduce the risk of cervical cancer. Self-collection of a vaginal specimen has been shown to increase participation. The relative clinical accuracy of human papillomavirus (HPV) testing on first-void urine (with Colli-Pee) and on vaginal self-samples versus on cervical clinician-collected samples is being investigated in the VALHUDES trial. The current study assesses attitudes and experiences regarding self-sampling among women enrolled in VALHUDES.

Methods: Questionnaires from 515 women (age 25-64 years [N = 498]; < 25 [N = 10], age ≥ 65 [N = 3], enrolled between December 2017 - January 2020) referred to colposcopy because of previous cervical abnormalities and enrolled in VALHUDES (NCT03064087) were analysed.

Results: Of the 515 participants, nearly all women confirmed that self-sampling may help in reaching under-screened women (93%). Nevertheless, 44% of the participants stated before starting collection that a clinician-collected sample is more effective than a self-collected sample. After self-sampling, the large majority of women (> 95%) declared that instructions for self-collection were clear, that collection was easy, and that they were confident about having performed the procedure correctly, for both urine and vaginal collection. However, a proportion of women found self-sampling unpleasant (9.5% [49/515] for urine collection; 18.6% [96/515] and 15.5% [80/515] for vaginal sampling with cotton swabs or plastic brushes, respectively). For their next screening round, 57% would prefer self-sampling whereas 41% opted for collection by a clinician. Among women preferring self-sampling, 53% would choose for urine collection, 38% for vaginal self-collection and 9% had no preference. Age did not modify preferences.

Conclusion: We conclude that both urine and vaginal self-sampling are well accepted by women, with a preference for urine sampling. Although the large majority of women are confident in their ability to perform self-sampling, four to five over ten women preferred specimen collection by a clinician.

Trial registration: The study VALHUDES was registered in ClinicalTrials.gov (identifier: NCT03064087 ).

Keywords: Attitudes; Cervical cancer; HPV; Human papillomavirus; Preferences; Screening; Self-sampling; Urine; VALHUDES.

Conflict of interest statement

H De Pauw, E Peeters and M Arbyn are supported by the RISCC Network funded by the Horizon 2020 Framework of DG Research and Innovation, European Commission, Brussels, Belgium (grant No. 847845). S Van Keer is supported by a junior postdoctoral fellowship of the Research Foundation – Flanders (FWO), Belgium (Grant Number: 1240220 N). A Vorsters is co-founder of Novosanis (Belgium), a spin-off company of the University of Antwerp, and was minority shareholder until January 2019. D Vanden Broeck is employed by AML, a commercial lab performing cervical cytology and HPV testing. All other authors declare no personal conflicts of interest.

© 2021. The Author(s).

Figures

Fig. 1

Patients’ preferences for their next screening: self-sampling or sampling by a clinician (N = 505). aSelf-sampling (n = 288/505, blue pie). bSampling by a clinician (n = 207, orange pie) [197 by gynaecologist (gyn), 8 by general practitioner (GP), 2 by either[ GP or gyn]]; cNo preference (n = 10/505, grey pie)

Fig. 2

Choice of devices among women preferring self-sampling at their next screening (N = 288). aUrine collection (n = 152/288, green pie); bVaginal self-sampling (n = 111/288, blue pie); cNo preference (n = 25/288, yellow pie)