We can do it!
Top Line: The Dutch have already shown that a woman can feasibly screen her own cervix for high-risk HPV as cancer prevention, so the obvious next step is to show large-scale effectiveness.
The Study: Self-sampling brushes performed in the comfort of one’s own home has the promise of increasing the number of women willing and able to stay current on cervical cancer screening with the added bonus of decreased healthcare costs. The non-inferiority IMPROVE trial randomized over 16K women to a standard Dutch screening program of cervical brushing via primary care physician versus the investigational screening at home with an Evalyn Brush. Brushings from both groups were then PCR-tested for 14 high-risk HPV types. Upon a positive HPV test, brushings collected via physician underwent reflex cytology testing while those collected at home prompted a brushing via physician for cytology testing. Abnormal cytology, in turn, prompted colposcopy for histologic evaluation for the primary endpoint of detection of CIN ≥2. The sensitivity and specificity, respectively, of detecting CIN 2-3 via self-sampling relative to standard physician sampling was 96% and 99% and of detecting CIN 3 was 99% and 100%. That is all to say, self-sampling was non-inferior.
Bottom Line: The effectiveness of self-sampling for high-risk strains of cervical HPV as a form of cancer screening leaves little room for improvement. | Polman, Lancet Oncol 2019
The Study: Self-sampling brushes performed in the comfort of one’s own home has the promise of increasing the number of women willing and able to stay current on cervical cancer screening with the added bonus of decreased healthcare costs. The non-inferiority IMPROVE trial randomized over 16K women to a standard Dutch screening program of cervical brushing via primary care physician versus the investigational screening at home with an Evalyn Brush. Brushings from both groups were then PCR-tested for 14 high-risk HPV types. Upon a positive HPV test, brushings collected via physician underwent reflex cytology testing while those collected at home prompted a brushing via physician for cytology testing. Abnormal cytology, in turn, prompted colposcopy for histologic evaluation for the primary endpoint of detection of CIN ≥2. The sensitivity and specificity, respectively, of detecting CIN 2-3 via self-sampling relative to standard physician sampling was 96% and 99% and of detecting CIN 3 was 99% and 100%. That is all to say, self-sampling was non-inferior.
Bottom Line: The effectiveness of self-sampling for high-risk strains of cervical HPV as a form of cancer screening leaves little room for improvement. | Polman, Lancet Oncol 2019
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