# Self-collected HPV samples are as accurate as clinician samples and reach women who never attend screening

Source: https://onco.cc/key-papers/paper-hpv-self-sampling-bmj-2018/  
OnCo record `paper-hpv-self-sampling-bmj-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A meta-analysis of 56 accuracy studies and 25 randomised trials found that self-sampled swabs tested with PCR detect precancer as well as clinician-taken samples, and mailing kits to under-screened women roughly doubles participation.

## Summary

Arbyn and colleagues pooled diagnostic accuracy studies comparing HPV testing on self-collected versus clinician-collected samples, and randomised trials comparing strategies to reach under-screened women.

With PCR-based assays, sensitivity for CIN2+ and CIN3+ on self samples was equivalent to clinician samples (relative sensitivity 0.99) and specificity was marginally lower (0.98). Signal-amplification assays performed worse on self samples. Mailing self-sampling kits to all under-screened women increased participation more than twofold compared with an invitation letter, as did door-to-door offers; opt-in kits produced smaller gains.

The findings underpin WHO and national guidance that self-sampling is an acceptable primary screening method.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: BMJ
- Year: 2018
- DOI: 10.1136/bmj.k4823
- Authors: Arbyn M, Smith SB, Temin S, Sultana F, Castle P
- Findings: PCR-based assays: pooled relative sensitivity of self vs clinician samples 0.99 for CIN2+, relative specificity 0.98; Signal-amplification assays were less sensitive on self samples (relative sensitivity 0.85 for CIN2+); Mailing kits to under-screened women increased participation about 2.3-fold versus invitation letters; Opt-in approaches (women must request a kit) gave only modest participation gains
- What it means: Women can collect their own screening sample at home with no loss of accuracy if the laboratory uses a PCR test. Sending kits directly is the most effective way to reach women who do not attend, which matters because most cervical cancers occur in under-screened women.
- Caveats: Accuracy equivalence holds only for PCR-based assays validated for self samples; Triage of positive self-samples still requires a clinic visit; follow-up completion is the weak point; Participation trials were heterogeneous in setting and delivery; Self-sampling for cytology (rather than HPV) is not supported

## Sources

- DOI: https://doi.org/10.1136/bmj.k4823

## Connected records

- ideas: [HPV self-testing with same-day treatment as the national cervical programme](https://onco.cc/ideas/idea-acc-hpv-self-sample-same-day-ablation/), [Post every woman an HPV self-test kit instead of asking her to book a smear](https://onco.cc/ideas/idea-prev-hpv-self-sampling-mailed-default/), [Same-day HPV test and heat treatment of precancer by nurses in low-income settings](https://onco.cc/ideas/idea-prev-hpv-same-day-screen-and-treat/)
- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [BMJ](https://onco.cc/journals/bmj/)
- people: [Mark Schiffman](https://onco.cc/people/mark-schiffman/)

---
JSON: https://onco.cc/api/v1/entities/paper-hpv-self-sampling-bmj-2018.json