• Br J Gen Pract · Aug 2022

    Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women.

    • Rebecca Landy, Tony Hollingworth, Jo Waller, Laura Av Marlow, Jane Rigney, Thomas Round, Peter D Sasieni, and Anita Ww Lim.
    • Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, US.
    • Br J Gen Pract. 2022 Aug 1; 72 (721): e538e545e538-e545.

    BackgroundCervical cancer incidence and mortality are high in women aged ≥65 years, despite the disease being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause.AimTo examine test performance and acceptability of human papillomavirus (HPV) testing on clinician-collected vaginal samples without a speculum (non-speculum).Design And SettingCross-sectional study in 11 GP practices and four colposcopy clinics in London, UK, between August 2017 and January 2019.MethodNon-speculum and conventional (speculum) samples were collected from women aged ≥50 years attending for a colposcopy (following a speculum HPV-positive screening result) or women aged ≥35 years (with confirmed cervical intraepithelial neoplasia (CIN) 2+), and women aged 50-64 years attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among women with negative cytology (routine screening).ResultsThe sensitivity of non-speculum sampling for detecting CIN2+ was 83.3% (95% confidence interval [CI] = 60.8 to 94.2) (n = 15/18). There was complete concordance among women with positive CIN2+ who had a speculum sample ≤91 days prior to the non-speculum sample (n = 12). Among 204 women with negative cytology, the specificity to HPV was 96.4% (95% CI = 92.7 to 98.5), with 96.6% concordant results (κ 72.4%). Seventy-one percent (n = 120/170) of women preferred a non-speculum sample for their next screen.ConclusionHPV testing on non-speculum clinician-taken samples is a viable approach that warrants further exploration in larger studies. Overall test performance was broadly comparable with that of self-sampling.© The Authors.

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