Feasibility of screening medically underserved rural women for cervical cancer using self-collected vaginal swabs and patient navigation

Objective: The purpose of this study was to: 1) determine the feasibility of using self-collected vaginal swabs to screen medically underserved rural women in Appalachian Kentucky for infection with oncogenic human papillomavirus (OHPV), and 2) determine the prevalence of OHPV and undiagnosed cervical dysplasia and/or neoplasia within this population in an effort to educate women and improve early intervention and treatment. Methods: Over seven months, female nurses recruited 150 women from free clinics, health departments, substance abuse treatment centers, and participants' homes. Inclusion criteria included: 1) no Pap test within the past three years, 2) age 30-65 and 3) sexual activity within the past year. Nurses explained the self-collection technique to participants. The specimens were analyzed using the genotype-specific Roche Linear Array assay. Results: One hundred fifty women were enrolled over a seven-month period. Forty-three percent tested positive for at least one high-risk OHPV type. Of these, 81.5% expressed willingness to be navigated to a clinic for further evaluation. Recruitment continues, and navigation has been underway for approximately two months. To date, six women have received a follow-up Pap test. One Pap resulted in a finding of abnormal, low-grade squamous intraepithelial lesion (LSIL). Conclusion: In areas of rural America, women not being screened for cervical cancer by Pap testing may be agreeable to HPV screening through self-collected swabs. This screening may yield high point prevalence and subsequent navigation may produce a significant number of cases showing dysplasia or cervical intraepithelial neoplasia (CIN), thereby averting increased rates of morbidity and mortality.