THE EFFECTIVENESS AND ACCEPTABILITY OF SELF-SAMPLING AGAINST THIN PREP PAP SMEAR

1. THE EFFECTIVENESS AND ACCEPTABILITY OF SELF-SAMPLING AGAINST THIN PREP PAP SMEAR IN UNIVERSITI MALAYA MEDICAL CENTRE (UMMC) Ainul Aziz, Hamsatul A. H., Si Lay Khaing, B.K.Lim, Siti Zawiah OmarUniversiti Malaya, Kuala Lumpur OPTIONALLOGO HERE Objectives Methods Results Conclusions INTRODUCTION : Cervical cancer is one of the most common cancers in women worldwide. In Malaysia, Cancer of the cervix is the third most common cancer among women. The primary test used to screen for precancerous abnormalities and cervical cancer has been the Papanicolaou test (Pap Test). Since its introduction in the 1930s, the Pap test has been the frontline test used to screen for precancerous abnormalities. As a result, cervical cancer mortality has declined by 70% in countries with near-universal screening programs. Pap testing is recommended for women who have been sexually active, exposed to HPV or whom are more than 18 years of age. Most women who develop cervical cancer have never had a Pap smear. The use of self sampling for Pap smear testing at the doctor’s office or at home would eliminate the need for a speculum examination and would convert cervical cancer screening to a simple laboratory test. Moreover, women overwhelmingly seem to favour self sampling to the traditional speculum examination. This is an extremely important factor for initial compliance with a screening program and also women at high risk who must be screened more often. OBJECTIVE : The objective of the study is that the use of a self-sampling device will be more acceptable to Malaysian women and that the self-sampling device has an acceptable analytic sensitivity to detect precancerous abnormalities. Method of study:This is a cross sectional study which has been conducted in 10 months from October 2010 till July 2011. The inclusion criteria of the subjects are non-pregnant women, between the age of 18 to 65 years old with sexual exposure of at least once, and who are willing to participate in the study. Woman with history of hysterectomy, known HPV infection, CIN or cervical cancer were excluded. Method of sample taking: Two samples were taken from each patient. First, by physician directed smear (Thin Prep) where the attending physician used a CytoBrush (Thin Prep) to collect the cervical specimen. Second sample was taken using Fournier’s sampler (Picture) where the participating woman was instructed to insert the device about 5 cm into the vagina till it meets with resistance. The sampler is then rotated 3 to 5 times before it is withdrawn and placed into a specimen collection tube. Each sample was evaluated for the following features: (1) specimen adequacy including the cellularity of squamous cells, presence or absence of endocervical/transformation zone cells, obscuring factors such as inflammatory and red blood cells (RBCs), and mucus; (2) cellular morphology. All slides with a low grade or high grade abnormality were recalled for a colposcopic examination. The mean age of the subjects was 40.1 (range 22 to 65). The Self-sampling device may form an attractive alternative screening tool The usage of self-sampling device as a screening tool in the context of detection cervical premalignant cells is limited, albeit well acceptable to the local community. Table 1: Comparison of adequacy obtained between endocervical brush samples and cervicovaginal self-sampling References • (1) National Cancer Registry 2006, Malaysia. • (2) Papanicolaou GN, Traut HF. The diagnostic value of vaginal smears in carcinoma of the uterus. Am J Obstet Gynecol 1941;42:193–206. • (3) Guzick DS. Efficacy of screening for cervical cancer: a review. Am J Public Health 1978;68:125–34. • (4) JohannesonG, G.G. (1978). The effect of mass screening in Iceland on the incidence and mortality of cervical carcinoma. Int J Cancer, 21: 418-425. • (5) Walboomers, J., Jacobs, M., Mano, M., & et al., e. (1999). Human Papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol., 189:12-19. • (6) Bosch, F.X., Manos, M.M., Munoz, N., Sherman, M., A.M. Jansen, A.M., Peto, J., et al. (1995). Prevalence of Human Papillomavirus in cervical cancer: a worldwide prospective. J. Natl Cancer Inst, 87: 796-802. • (7) Wright T.C.,Schiffman M., Solomon D., Cox J.T., Garcia F, Goldie S, et al (2004). Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology. Obstet Gynaecol, 103: 304-309. • (8) Wong L P, W.Y. (2009) Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: a qualitative study. Singapore Med J, 50 (1): 49 • (9) Hillemanns P, Kimmig R, Huttemann U et al. Screening for cervical neoplasia by self-assessment for Human Papillomavirus DNA. The Lancet 2000; 345: 1532. • (10) Nor Hayati O. (2003) From cancer of the cervix- Bleak past to bright future; A review with an emphasis on cancer of the cervix in Malaysia. Malaysian journal of medical sciences, 10(1): 13-26. • (11) Castle P, Aftab A, Saint-Jean G,Luis-Mendez L. (2006). Detection of carcinogenic human papillomavirus in specimens collected with a novel self-sampling device. J Clin Microbiology, Vol 44, No. 6: 2158-2159. • (November 5, 2002) Cervical specimen self-sampling device. Fournier, US. Patent No. 6,475,156. United States Patent office. • (13) Wright T, Denny L, Kuhn L, Pollack A et al (2000). HPV DNA testing of self-collected vaginal samples compared with cytological screening to detect cervical cancer, JAMA, 283: 81-86. • (14) Belinson J, Qiao Y, Pretorius R, Zhang W, Rong S, Huang D et al (2003). Shanxi province cervical cancer screening study II: Self-sampling for high-risk human papillomavirus compared to direct sampling for human papillomavirus and liquid-based cervical cytology. Int J Gynaecol cancer, 13: 819-826. • (15) Ovadia Abulafia, M.D.,a,* John C. Pezzullo, Ph.D.,a,b and David M. Sherer, M.D. Performance of ThinPrep liquid-based cervical cytology in comparison with conventionally prepared Papanicolaou smears: a quantitative survey. • (16) John W. Sellors,* Attila T. Lorincz, James B. Mahony, Iwona Mielzynska, Alice Lytwyn, Paula Roth, Michelle Howard, Sylvia Chong, Dean Daya, William Chapman, Max Chernesky. Comparison of self-collected vaginal, vulvar and urine samples with physician-collected cervical samples for human papillomavirus testing to detect high-grade squamous intraepithelial lesions. CMAJ 2000;163(5):513-8 • (17) Neerja Bhatla a, Lalit Dar, A. Rajkumar Patro, Pankaj Kumar, Alka Kriplani, Arti Gulati, Venkateswaran K. Iyer , Sandeep R. Mathur , Vishnubhatla Sreenivas , Keerti V. Shah , Patti E. Gravitt . Can human papillomavirus DNA testing of self-collected vaginal samples compare with physician-collected cervical samples and cytology for cervical cancer screening in developing countries? Cancer Epidemiology 33 (2009) 446–450 Table 2: Comparison of cytology results from endocervical brush samples and self obtained samples. The agreement between LBC results (normal cytology versus borderline dyskaryosis or worse) between the two sampling methods was poor (k = 0.138). • Table 3: Acceptability of self-sampling • Only 18% of the women are not willing to perform self-sampling at home. The main reason was that the results would not be accurate. • Of the 209 women who are willing to perform self-sampling at home, 150 of them (72%) said that they are willing to send it back by post.