17

CHAPTER III

DISCUSSION

The use of self-collected samples for HPV testing has the potential to improve

markedly womens participation in cervical cancer screening programs and to

reduce the burden of screening on the clinics, but literature on the acceptability of

this procedure is scarce. The use of self-sampling in early detection programs

could improve coverage rates by attracting women who would otherwise not

come because they refuse to get a Pap test. The simplicity of the instructions and

the collection procedure to obtain the vaginal sample make incorporation of this

technique into the current screening program highly feasible. The adjunct of self-

sampling, therefore, could likely improve the coverage of screening programs by

providing an alternative for women who currently do not participate in early

detection programs worldwide.4,8

The results of the study indicate that self-collection for HPV testing is more

acceptable than the Pap test and that the distinction in test preference is

significant. Both the Pap test and selfsampling are acceptable to younger women.

The probability of experiencing more pain, discomfort, embarrassment, and less

privacy was always higher for the Pap test than for self-sampling. Embarrassment

proved to be the greatest obstacle to the acceptability of the Pap test and,

therefore, of Pap test-based cervical cancer screening programs. Younger,

wealthier, and more educated women were more likely to be less embarrassed by

self-sampling than the Pap test. It is not surprising that embarrassment with the
 17

Pap test increased with age. Older women have less experience with the Pap test

and with pelvic examinations outside of childbirth. In contrast, the selfsampling

procedure practically eliminated any embarrassment involved with screening,

regardless of demographic characteristics.4,5,8

In the setting of primary screening for cervical disease, testing of self-

collected vaginal samples for high-risk HPV types detected as many cases of

high-grade SIL (CIN, 2-3) and invasive cervical cancer as did a conventional Pap

smear.9

Testing for HPV DNA by self-collected vaginal swabs at the time a woman

provides a routine urine sample would eliminate the need for a specu-lum

examination and would convert cer-vical cancer screening to a simple labo-ratory

test. In addition to being used for HPV DNA testing, self-collected vagi-nal swabs

have also been shown to be acceptable as a method to detect C trachomatis,

bacterial vaginosis, and T vaginalis. Although HPV DNA testing of self-collected

vaginal samples has a num-ber of advantages for selected popula-tions, this

approach is not without limitations. One limitation is that sim-ply identifying

women as being high-risk for HPV does not guarantee that they will return for

either colposcopic evaluation or treatment. Another po-tential limitation of

screening using self-collected vaginal samples is that HPV DNA testing has a

lower specificity than cytologic screening and that the sensi-tivity of HPV DNA

testing of self-collected specimens is significantly less than that of HPV DNA

testing of clini-cian-obtained cervical specimens.9