The Influence of Vaginal HPV Self-Sampling on the Efficacy of Populational Screening for Cervical Cancer—An Umbrella Review

SIMPLE SUMMARY: Cervical cancer (CC) is a common malignancy in the female population, resulting in a significant reduction in the quality of life and premature deaths. Since the prognosis depends on the stage of the disease, screening programs are of great importance in the management of cervical cancer. Several screening tests are available for this type of malignancy. Self-collection of vaginal samples for HPV tests is becoming increasingly popular; therefore, the objective of this umbrella review was to analyze the available data on their reliability. Secondary evidence from examinations of the sensitivity and specificity of the test, screening reportability data, the acceptance rates, and the cost-effectiveness of the method were taken into account. The review confirms the high usefulness of self-sampling in the early detection of CC as being due to increased uptake rates. Self-sampling is an effective and feasible modality for screening examinations which may be particularly important in the context of possible systemic changes in countries where CC screening is carried out by other methods and the screening uptake rates are low. ABSTRACT: Introduction: Early detection of cervical cancer is a matter of great importance as the prognosis depends on the stage of the disease. The objective of the study consisted in the assessment of the impact of HPV self-sampling on the efficacy of populational screening programs aimed at early CC detection. Methods: The analysis was performed taking into account the Cochrane Collaboration guidelines for systematic reviews. The analyzed articles were searched for in the following databases: Medline (PubMed), Embase (Ovid), and Cochrane Library. Results: From a total of 60 citations, 16 studies were included in this review. The HPV test is highly sensitive and specific although the diagnostic accuracy of tests carried out in self-collected samples is slightly lower than that of tests carried out in samples collected by clinicians. The results of meta-analyses for HPV tests performed on self-collected samples indicate that the sensitivity for detecting CIN2+ ranges from 74% to 86% (depending on the publication and the analyzed population), and for CIN3+ from 75% to 86%. One publication showed a clearly lower sensitivity of 42% in detecting CIN3+, but the result is for a high-risk population and comes from only 1 RCT. The specificity of the assay exceeds 80% and 79.5% with regard to the detection of CIN2+ and CIN3+, respectively. As shown by the studies included in the review, both the offering of HPV self-sampling kits to patients and the mailing of such kits significantly increase the uptake of and participation in cervical cancer screening programs. In addition, self-sampling was found to be acceptable by the female subjects. Conclusions: HPV self-sampling is an innovative and cost-effective way to perform screening tests. In addition, self-sampling significantly increases the willingness to participate in screening programs among female subjects.