Abstract
Despite advances in diagnosis and treatment of the disease, many women in low and middle-income countries (LMICs) still die from cervical cancer because of their inability to access effective screening programmes. The use of self-sampling methods has been found to be highly effective and acceptable to women, especially those who do not present for screening. This method is an under-utilized but highly practical approach and should be integrated into health centres’ primary health care programmes.
Keywords
Cervical cancer continues to be one of the main causes of cancer-related deaths among women living in LMICs, even though it can be easily prevented. There is still a wide knowledge-practice gap. One of the most effective, yet underused, strategies is Human Papilloma Virus (HPV) self-sampling, which has the ability to revolutionize cervical cancer screening coverage and has not been incorporated yet in practice in many LMICs.1,2
Traditional programmes require patients’ attendance at a health facility, need the availability of properly trained healthcare providers and demand repeat appointments. Such obstacles affect those at greatest risk. 3 The remoteness of facilities, poverty, embarrassment, fear and hesitation regarding pelvic examination remain obstacles for women's participation. 4
Self-sampling is an ideal solution that not only removes such barriers but also makes HPV screening more patient-friendly. Self-collection not only enables women to collect their samples conveniently but also decreases the dependence on clinical infrastructure. There is solid evidence that the sensitivity of cervical samples collected by patients themselves is not inferior to that obtained by clinicians during screening.5,6 Even more importantly, self-sampling has been proven to increase participation rates among women who are never screened or under-screened.6,7
Nevertheless, the full-scale implementation of self-sampling has not been achieved. This is not due to a lack of research on the subject but from a reluctance to implement innovations in existing healthcare systems.
Many screening programmes in LMICs still use traditional models that are simply unable to reach the necessary number of high-risk women. 8 Objections relate to sample adequacy, quality assurance and follow-up strategies; however, these are common both in traditional and innovative approaches and can be handled successfully.5,7
In the absence of effective channels for confirmatory testing, treatment and follow-up, a mere increase in screening frequency does not necessarily translate into lower mortality. 8 Community health workers can prove helpful in distributing kits and educating patients. 9 Low-cost digital technology (viz. mobile phone videos) can facilitate the implementation of self-sampling programmes. Specifically, mobile electronic platforms for result delivery, follow-up reminders and monitoring will prevent loss to follow-up, which is a common problem in LMICs.6,10
High mortality from cervical cancer in LMICs arises not because of the lack of technological progress but from the reluctance to implement new methodology. HPV self-sampling should no longer be regarded as an experiment.1,3 Converting this research into practice is urgent. A focus on implementation is mandatory.
Footnotes
Acknowledgments
The authors acknowledge our parents and family members for their continuous support.
Author contributions
All authors contributed equally to the conception, drafting and final revision of the manuscript. All authors approved the article, and we both give surety that the manuscript represents honest work.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Data availability statement
No data were generated or analyzed for this article.