Widening The Offer of Human Papillomavirus Self-Sampling to All Women Eligible for Cervical Screening: Make Haste Slowly
Cet article analyse la pertinence, dans les pays à haut revenu, d'étendre l'auto-prélèvement d'échantillons cervicaux pour test HPV à l'ensemble des femmes éligibles aux programmes de dépistage du cancer du col de l'utérus
Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among under-screened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high-income countries with long-standing, organised cervical screening programmes, self-collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under- and well-screened women. For these contexts, a validated microsimulation model determined that adding self-collection to clinician collection is likely to be cost-effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We used these thresholds to review the ?early-adopter? programme-level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among under-screened women was accompanied by a high rate of substituting clinician sampling with self-collection among well-screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self-sampling vs. clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a follow-up triage test that required a clinician sample. To support real-world programmes on their pathways towards implementation and to avoid HPV self-collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation. This article is protected by copyright. All rights reserved.
International Journal of Cancer , résumé, 2022