Self-collected HPV Testing Improves Participation in Cervical Cancer - - PowerPoint PPT Presentation

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Self-collected HPV Testing Improves Participation in Cervical Cancer - - PowerPoint PPT Presentation

Mar 20, 2023 173 likes •316 views

Self-collected HPV Testing Improves Participation in Cervical Cancer Screening: Systematic Review and Meta-analysis C . S A R A I R A C E Y P H D S T U D E N T D A L L A L A N A S C H O O L O F P U B L I C H E A LT H U N I V E R S I T

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SLIDE 1

C . S A R A I R A C E Y

P H D S T U D E N T D A L L A L A N A S C H O O L O F P U B L I C H E A LT H U N I V E R S I T Y O F T O R O N T O C O - A U T H O R : D I A N A W I T H R O W

W O R L D C A N C E R C O N G R E S S A U G U S T 2 8 T H , 2 0 1 2 M O N T R E A L , Q U E B E C

Self-collected HPV Testing Improves Participation in Cervical Cancer Screening: Systematic Review and Meta-analysis

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SLIDE 2

Cervical Cancer and Cancer Screening

  • Human papillomavirus

(HPV) is a necessary cause of cervical cancer

  • Progressive disease
  • Screening programs

have dramatically reduced the incidence and mortality of cervical cancer through Pap testing

  • Participation in cervical cancer screening stagnated in

many countries with implemented screening programs

  • ~70% of eligible women in Ontario (target 85%)
  • How can we engage women to participate in cervical

cancer screening?

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SLIDE 3

HPV Testing & Cervical Cancer Screening

 Increasingly used as primary (or co-test) for cervical

cancer screening

 For detecting CIN2/3+ HPV testing:

! More sensitive (94.6% vs. 55.4%) than Pap testing ! Less specific (94.1% vs.96.8%) than Pap testing  Use in 30+year old women

 Improves the utility of Pap testing  Self-collected samples are comparable as physician

collected samples

! Self-collection is acceptable to women

(Mayrand et al. 2007)

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SLIDE 4

Barriers to Cervical Cancer Screening

! Clinic level barriers  Lack of access to primary care  Inconvenient clinic hours  Lack of transportation to clinic ! Test level barriers  Physical discomfort of Pap test  Embarrassment ! Individual level barriers  Cultural/religious values  Issues with intimate site contact

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SLIDE 5

Objective

! Examine the extent to which providing self-

sampled HPV testing increases participation in cervical cancer screening

 Compared to Pap testing  Among women who are inadequately screened  In countries with implemented cervical cancer

screening programs

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SLIDE 6

Methods – Systematic Review

Medline Embase

HPV Infection HPV Testing Cervical Cancer Self- sampling

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SLIDE 7

Methods – Systematic Review

Medline Embase

Title and abstracted "168 articles Full text " 17 articles Reviewed " 10 articles

HPV Infection HPV Testing Cervical Cancer Self- sampling

HPV self-sampling vs. Pap testing Participation # Control group (Pap testing invitation) # Group allocation stated # Inadequately screened women Excluded: Editorials, commentaries, unpublished, conference abstracts Duplicate datasets Ecological study designs Study origin developing country

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SLIDE 8

Review Results

Study Location Number of Participants HPV study Arm Compliance

  • f HPV arm

n(%) Control Pap Arm Compliance

  • f Pap Arm

n(%) Relative Compliance 95% CI Gok et al. 2012 Netherlands 26,409 25,561 7,7870 (30.8%) 261 17 (6.5%) 4.727 (2.984 - 7.488)* Szarewski et al. 2011 UK 3000 1,500 153 (10.2%) 1,500 68 (4.5%) 2.250 (1.701 - 2.967)* Giorgi et al. 2011 Italy 1235 616 121 (19.6%) 619 86 (13.9%) 1.414 (1.098 - 1.821)* Wikstrom et al. 2011 Sweden 4060 2,000 779 (39.0%) 2,060 188 (9.1%) 4.268 (3.685 - 4.943)* Virtanen et al. 2011 Finland 8699 2,397 756 (31.5%) 6,302 1,631 (25.9%) 1.219 (1.134 - 1.310*) Castle et al. 2011 US 119 77 62 (80.5%) 42 17 (40.5%) 1.989 (1.357 - 2.917)* Lazcano-Ponce et al. 2011 Mexico 25,061 9,371 9,202 (98.2%) 12,731 11,054 (86.8%) 1.131 (1.123 - 1.139)* Piana et al. 2011 France 9.334 3,552 939 (26.4%) 4,305 311 (7.2%) 3.659 (3.245 - 4.127)* Gok et al. 2010 Netherlands 27,163 26,886 7,455 (27.7%) 277 46 (16.6%) 1.670 (1.282 - 2.175)* Bias et al. 2007 Netherlands 2624 2,352 806 (34.3%) 272 48 (17.6%) 1.942 (1.493 - 2.525)* *Statistically significant <0.01 HPV Study Arm Control Study Arm

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SLIDE 9

Review Results

Study Location Number of Participants HPV study Arm Compliance

  • f HPV arm

n(%) Control Pap Arm Compliance

  • f Pap Arm

n(%) Relative Compliance 95% CI Gok et al. 2012 Netherlands 26,409 25,561 7,7870 (30.8%) 261 17 (6.5%) 4.727 (2.984 - 7.488)* Szarewski et al. 2011 UK 3000 1,500 153 (10.2%) 1,500 68 (4.5%) 2.250 (1.701 - 2.967)* Giorgi et al. 2011 Italy 1235 616 121 (19.6%) 619 86 (13.9%) 1.414 (1.098 - 1.821)* Wikstrom et al. 2011 Sweden 4060 2,000 779 (39.0%) 2,060 188 (9.1%) 4.268 (3.685 - 4.943)* Virtanen et al. 2011 Finland 8699 2,397 756 (31.5%) 6,302 1,631 (25.9%) 1.219 (1.134 - 1.310*) Castle et al. 2011 US 119 77 62 (80.5%) 42 17 (40.5%) 1.989 (1.357 - 2.917)* Lazcano-Ponce et al. 2011 Mexico 25,061 9,371 9,202 (98.2%) 12,731 11,054 (86.8%) 1.131 (1.123 - 1.139)* Piana et al. 2011 France 9.334 3,552 939 (26.4%) 4,305 311 (7.2%) 3.659 (3.245 - 4.127)* Gok et al. 2010 Netherlands 27,163 26,886 7,455 (27.7%) 277 46 (16.6%) 1.670 (1.282 - 2.175)* Bias et al. 2007 Netherlands 2624 2,352 806 (34.3%) 272 48 (17.6%) 1.942 (1.493 - 2.525)* *Statistically significant <0.01 HPV Study Arm Control Study Arm

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SLIDE 10

Review Results

Study Location Number of Participants HPV study Arm Compliance

  • f HPV arm

n(%) Control Pap Arm Compliance

  • f Pap Arm

n(%) Relative Compliance 95% CI Gok et al. 2012 Netherlands 26,409 25,561 7,7870 (30.8%) 261 17 (6.5%) 4.727 (2.984 - 7.488)* Szarewski et al. 2011 UK 3000 1,500 153 (10.2%) 1,500 68 (4.5%) 2.250 (1.701 - 2.967)* Giorgi et al. 2011 Italy 1235 616 121 (19.6%) 619 86 (13.9%) 1.414 (1.098 - 1.821)* Wikstrom et al. 2011 Sweden 4060 2,000 779 (39.0%) 2,060 188 (9.1%) 4.268 (3.685 - 4.943)* Virtanen et al. 2011 Finland 8699 2,397 756 (31.5%) 6,302 1,631 (25.9%) 1.219 (1.134 - 1.310*) Castle et al. 2011 US 119 77 62 (80.5%) 42 17 (40.5%) 1.989 (1.357 - 2.917)* Lazcano-Ponce et al. 2011 Mexico 25,061 9,371 9,202 (98.2%) 12,731 11,054 (86.8%) 1.131 (1.123 - 1.139)* Piana et al. 2011 France 9.334 3,552 939 (26.4%) 4,305 311 (7.2%) 3.659 (3.245 - 4.127)* Gok et al. 2010 Netherlands 27,163 26,886 7,455 (27.7%) 277 46 (16.6%) 1.670 (1.282 - 2.175)* Bias et al. 2007 Netherlands 2624 2,352 806 (34.3%) 272 48 (17.6%) 1.942 (1.493 - 2.525)* *Statistically significant <0.01 HPV Study Arm Control Study Arm

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SLIDE 11

Review Results

Study Location Number of Participants HPV study Arm Compliance

  • f HPV arm

n(%) Control Pap Arm Compliance

  • f Pap Arm

n(%) Relative Compliance 95% CI Gok et al. 2012 Netherlands 26,409 25,561 7,7870 (30.8%) 261 17 (6.5%) 4.727 (2.984 - 7.488)* Szarewski et al. 2011 UK 3000 1,500 153 (10.2%) 1,500 68 (4.5%) 2.250 (1.701 - 2.967)* Giorgi et al. 2011 Italy 1235 616 121 (19.6%) 619 86 (13.9%) 1.414 (1.098 - 1.821)* Wikstrom et al. 2011 Sweden 4060 2,000 779 (39.0%) 2,060 188 (9.1%) 4.268 (3.685 - 4.943)* Virtanen et al. 2011 Finland 8699 2,397 756 (31.5%) 6,302 1,631 (25.9%) 1.219 (1.134 - 1.310*) Castle et al. 2011 US 119 77 62 (80.5%) 42 17 (40.5%) 1.989 (1.357 - 2.917)* Lazcano-Ponce et al. 2011 Mexico 25,061 9,371 9,202 (98.2%) 12,731 11,054 (86.8%) 1.131 (1.123 - 1.139)* Piana et al. 2011 France 9.334 3,552 939 (26.4%) 4,305 311 (7.2%) 3.659 (3.245 - 4.127)* Gok et al. 2010 Netherlands 27,163 26,886 7,455 (27.7%) 277 46 (16.6%) 1.670 (1.282 - 2.175)* Bias et al. 2007 Netherlands 2624 2,352 806 (34.3%) 272 48 (17.6%) 1.942 (1.493 - 2.525)* *Statistically significant <0.01 HPV Study Arm Control Study Arm

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SLIDE 12

Meta-analysis Results

  • All 10 studies were used

to calculate combined measure

  • Random Effects Model
  • I2 statistic for

heterogeneity

  • Sensitivity analysis was

conducted to remove the two non-European studies

effects analysis .000) 2.14 (1.30, 3.52) 2.25 (1.71, 2.97) 1.22 (1.13, 1.31) 4.73 (2.98, 7.49) 1.67 (1.28, 2.18) 1.41 (1.10, 1.82) 4.27 (3.68, 4.94) 1.13 (1.12, 1.14) 1.99 (1.36, 2.92) 3.66 (3.24, 4.13) 1.94 (1.49, 2.53) 2.14 (1.30, 3.52) 2.25 (1.71, 2.97) 1.22 (1.13, 1.31) 4.73 (2.98, 7.49) 1.67 (1.28, 2.18) 1.41 (1.10, 1.82) 4.27 (3.68, 4.94) 1.13 (1.12, 1.14) 1.99 (1.36, 2.92) 3.66 (3.24, 4.13) 1.94 (1.49, 2.53) 1 .1 1 10

RR (95% CI) Relative Risk

Combined relative compliance = 2.14 (95%CI 1.30 – 3.52)

Sensitivity analysis

!

Combined relative compliance = 2.34 (1.47 – 3.70 95% CI)

NOTE: Weights are from random effects analysis Overall (I-squared = 99.5%, p = 0.000)

2.14 (1.30 – 3.52)

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SLIDE 13

Conclusions

 Overall findings:

! Providing HPV self-testing to inadequately screened women

could improve participation 2- fold in cervical cancer screening compared to offering Pap tests

! Majority of studies were conducted in urban European settings ! Provision of HPV self-testing requires investment in

infrastructure to ensure appropriate follow-up and care are available

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SLIDE 14

Acknowledgements

Co-author: Diana Withrow Dissertation Committee:

  • Dr. Dionne Gesink, Supervisor
  • Dr. Ann Burchell
  • Dr. Tom Wong

Funding: University of Toronto