Cervical cancer is considered an important public health problem especially in developing countries1. In Brazil, some populations, for instance the women who live in rural areas, are most vulnerable to the absence of screening organized programs that can provide an extensive coverage and follow up of suspect cases. The possibility of less invasive tests based on self-sample and performed in a domestic environment can increase acceptance rates on screening tests in comparison to the conventional Pap smear. The aim of this study was to evaluate the feasibility of a cervical cancer screening strategy in women who lived/worked in rural areas by using self-sampled tests to detect HPV offered by the Military Police Team, which is responsible to take care of these regions.
We performed a cross sectional study with prospective collection data from February 2015 to June 2016. The study was developed by Prevention Department of Barretos Cancer Hospital, Barretos, Brazil in partnership and financed by AMIGOH (Einstein’s friends of Oncology and Hematology) which is one arm of the Albert Einstein Benefit Society. We enrolled 386 woman who were employed or lived in rural areas of Barretos, between the ages of 25 and 78 years old (average=41,3). It was offered to the participants the possibility of self-sampled tests to detect high risk HPV which were after processed using Cobas 4800® System (Roche Diagnostics, Laval, Quebec, Canada). This system can provide the detection of 14 high-risk HPV types in a single analysis. The test was offered to each participant by one member of the Military Police (female soldier). All woman with a positive result (HPV positive) were invited to a colposcopy evaluation.
95,6% of woman interviewed accepted the study and performed the self-sample. The main reasons to refuse the study were: “being afraid of getting hurt” and “not consider herself able to perform the test”. In a total of 340 woman with a valid test, 45 (13,2%) had a positive result for HPV infection of at least one subtype. The combination of the results (colposcopy evaluation and the pathologic results for HPV positive participants) detected 46.3% benign findings, 41.5% CIN1, 7.3% CIN2/3 and 4.9% with invasive squamous cell carcinoma.
The high acceptance of self-sampled test, even when not offered by health professionals, showed the potential of this strategy as a complementary instrument on cervical cancer screening, mainly to populational groups non adherent to the conventional strategies.
1.[Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893-917].