{"entity":{"id":"paper-hpv-self-sampling-bmj-2018","kind":"paper","name":"Self-collected HPV samples are as accurate as clinician samples and reach women who never attend screening","aka":[],"tldr":"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.\n\nWith 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.\n\nThe findings underpin WHO and national guidance that self-sampling is an acceptable primary screening method.","asOf":"2026-09-08","links":[{"label":"DOI","url":"https://doi.org/10.1136/bmj.k4823"}],"tags":[],"related":["idea-prev-hpv-self-sampling-mailed-default","idea-prev-hpv-same-day-screen-and-treat","idea-acc-hpv-self-sample-same-day-ablation"],"cancers":["cervical"],"sections":["early-detection","prevention"],"technologies":["hpv-testing","hpv-vaccine"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-prevention-adoption","b-global-access","b-early-detection"],"keyPapers":[],"journals":["bmj"],"dependsOn":[],"notes":[],"journal":"BMJ","year":2018,"doi":"10.1136/bmj.k4823","pmid":"30518635","authors":"Arbyn M, Smith SB, Temin S, Sultana F, Castle P","paperType":"meta-analysis","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"],"whatItMeans":"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"],"changedPractice":true},"route":"/key-papers/paper-hpv-self-sampling-bmj-2018/","neighbours":{"idea":[{"id":"idea-acc-hpv-self-sample-same-day-ablation","kind":"idea","name":"HPV self-testing with same-day treatment as the national cervical programme","route":"/ideas/idea-acc-hpv-self-sample-same-day-ablation/"},{"id":"idea-prev-hpv-self-sampling-mailed-default","kind":"idea","name":"Post every woman an HPV self-test kit instead of asking her to book a smear","route":"/ideas/idea-prev-hpv-self-sampling-mailed-default/"},{"id":"idea-prev-hpv-same-day-screen-and-treat","kind":"idea","name":"Same-day HPV test and heat treatment of precancer by nurses in low-income settings","route":"/ideas/idea-prev-hpv-same-day-screen-and-treat/"}],"cancer":[{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"hpv-vaccine","kind":"technology","name":"HPV & HBV vaccination","route":"/technologies/hpv-vaccine/"},{"id":"hpv-testing","kind":"technology","name":"HPV DNA testing and self-sampling","route":"/technologies/hpv-testing/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"bmj","kind":"journal","name":"BMJ","route":"/journals/bmj/"}],"person":[{"id":"mark-schiffman","kind":"person","name":"Mark Schiffman","route":"/people/mark-schiffman/"}]}}