It was estimated that approximately...

It was estimated that approximately 12000 of recent origin cases of cervical cancer and 4000 deaths attributed to cervical cancer would appear in the United States in 2003 Worldwide, cervical cancer is the leading cause of morbidity and mortality from all gynecologic cancers. Although screening programs can dramatically shorten mortality, they frequently do not reach the women mostly at risk because of sumptuousness cultural problems, or problems in the organization of health services. Garcia and colleagues ordealed the feasibility of using patient-collected samples for cervical cytology and detection of oncogenic human papillomavirus (HPV) as a means of extending screening programs to women with limited resources.

The authors recorded 334 women who attended colposcopy clinics in Arizona, Mexico, and Peru Exclusions were pregnancy, hysterectomy, or history of vaginal trauma or laceration. Each woman was instructed in the use of the endocervical brush and correct technique for placement of the specimen in containers for transport to a laboratory. Each woman was then examined by way of a physician who collected samples for cervical cytology and HPV testing. Finally, all women underwent thorough colposcopic examination, including directed biopsies. All specimens were trialed using standard techniques. All abnormal specimens and a randomly chosened sample of 10 percent of normal specimens were reviewed at an experienced cytopathologist.

The mean age of the enlisted women was 36.9 years, and the mean parity was 23 undivided percent of patient-collected and 2 percent of physician-collected samples were assessed as unsatisfactory. Endocervical enclosed spaces were absent in 66 percent of patient-collected and 14 percent of physician-collected samples. For diagnosis of atypical squamous confined apartments using colposcopy as the gold standard, the sensitivity of patient-collected specimens was 55 percent and that of physician-collected samples was 85 percent (see accompanying table). The corresponding specificities were 84 and 73 percent For HPV patient-collected samples had significantly lower sensitivity than physician-collected samples (49 percent compared with 82 percent) unless comparable specificity (73 and 67 percent respectively). When cytology (abnormal doorsill of atypical squamous cells of undetermined significance [ASCUS] or greater) or HPV was positive, self-collect specimens had significantly lower sensitivity (75 percent compared with 951 percent) and negative predictive values (861 percent compared with 964 percent) than physician-collected samples. reciprocally specificities and positive predictive values were not significantly different between the pair techniques of collection.

The authors bring to an end that their results, plus those of other studies in developing countries of self-sampling for HPV and cytologic evidence of cervical abnormalities, indicate that self-sampling techniques may help discomfit barriers to screening for cervical cancer. Despite its limitations, self-sampling may be especially helpful in women at increased risk because of limited access to health services.

Garcia F et al. Cross-sectional application of mind of patient- and physician- amassed cervical cytology and human papillomavirus. Obstet Gynecol August 2003;102:226-72

COPYRIGHT 2004 American Academy of Family Physicians

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