Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
Cytology Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
Int J Cancer. 2023 Jul 1;153(1):8-19. doi: 10.1002/ijc.34358. Epub 2022 Nov 23.
Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened 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 underscreened 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 toward 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.
自我采样进行人乳头瘤病毒（HPV）检测有可能增加未充分筛查女性的宫颈癌筛查率，并可能成为世卫组织 2030 年消除宫颈癌战略的重要组成部分。在宫颈癌筛查计划历史悠久且组织完善的高收入国家，自我采样越来越多地作为常规服务提供给女性，无论其筛查史如何，包括未筛查和充分筛查的女性。对于这些情况，经验证的微观模拟模型确定，只要满足以下特定标准，自我采样与临床医生采集相结合可能具有成本效益：（1） 接受率；（2） 检测高级别宫颈上皮内瘤变（CIN2+）的敏感性。我们使用这些标准来审查“早期采用者”方案层面的证据，以确定这些标准在多大程度上以及一致性如何得到满足。现有证据表明，在未充分筛查的女性接受率较低的情况下，有较高的临床医生采样被自我采样替代的风险，而对于充分筛查的女性，这种风险进一步增加。如果自我采样对 CIN2+的检测敏感性略低于临床医生采样，且缺乏遵循需要临床医生采样的随访分流测试，情况会更加复杂。为了支持现实世界方案的实施路径，并避免 HPV 自我采样作为一种具有适得其反后果的筛查措施被善意采用，我们最后确定了一系列缓解措施和值得优先研究的领域。
