Online Program

Evaluation of a mailed self-collection device to screen for high-risk HPV infection in under-screened women in North Carolina

Monday, November 4, 2013 : 8:45 a.m. - 9:00 a.m.

Andrea Des Marais, MPH, Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
Noel T. Brewer, PhD, Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC
Carolina Perez-Heydrich, PhD, Department of Biostatistics, Carolina Population Center, Chapel Hill, NC
Anna Pfaff, MPH, Community Care of Western North Carolina, Asheville, NC
Iesha Williams, Department of Psychology, North Carolina Central University, Durham, NC
Meagan Johnson, University of North Carolina at Chapel Hill, Chapel Hill, NC
Xian Brooks, North Carolina Central University, Durham, NC
Sara Smith, MPH, MSW, Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
Lynn Barclay, ASHA, American Social Health Association, Durham, NC
Jennifer S. Smith, PhD, Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC
BACKGROUND: About half of new U.S. cases of invasive cervical cancer are attributable to insufficient screening. Mailing at-home self-collection kits for HPV testing to high-risk women is a promising strategy to increase screening in hard-to-reach populations. OBJECTIVE: To test the validity and acceptability of a mailed self-collection HPV device among women not recently screened for cervical cancer, compared to clinic-based self- and clinician collection. METHODS: Study participants were low-income women aged 30 to 64 and unscreened for cervical cancer in 4 or more years (overdue by current recommendations). Participating women were asked to self-collect a cervical/vaginal sample at home; return the sample by mail; visit a local clinic for a second self-collected sample and physician-collected endocervical sample; and complete a questionnaire by phone. All self- and physician-collected samples were tested for high-risk (oncogenic) HPV mRNA. Physician-collected samples were also tested for cervical abnormalities using liquid-based cytology. RESULTS: Among 155 women recruited to date, most participants were white (70%) or African-American (21%), with median annual household income below $10,000. Most women returned self-collection kits (83%), completed clinic appointments (74%), and reported feeling mostly positive or neutral about self-collection (97%). High-risk HPV mRNA was detected in 12% of women, cervical abnormalities in 11%, and histologically confirmed CIN2+ (high-grade precancerous lesions) in 3%. Among participants with abnormal cytology, HPV results from home self-collection had 100% concordance with clinician collection. CONCLUSIONS: Home-based cervico-vaginal self-collection for HPV mRNA testing appears to be a well-accepted and clinically valid method of detecting high-risk HPV infection.

Learning Areas:

Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Assess the validity of at-home self-collected samples delivered via mailed kits for detecting high-risk HPV infection. Discuss the role that at-home self-collection for HPV testing could play in expanding cervical cancer screening uptake among rarely and never-screened women.

Keyword(s): Cervical Cancer, Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been project manager of the presented study for the past 2 years. I completed my MPH in health behavior and health education. In recent years, I have worked on multiple projects addressing cervical cancer screening methods, access, and uptake.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.