Human papillomavirus self-sampling for cervical cancer screening: Review on the acceptance, accuracy, feasibility and incorporation in the National Screening Programme of India

Amey Oak, K. Sivaranjini, Ruchi Pathak, R. Dikshit
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引用次数: 1

Abstract

Screening along with treatment is the foremost tool for cervical cancer elimination in addition to vaccination strategies. At present, India lacks a comprehensive screening programme. There are huge issues in terms of feasibility, acceptability and implementation of the existing cervical screening programme in the country. Less than 2% (Urban-2.2% and Rural-1.7%) of women in India have been screened. The current strategy recommended by Ministry of Health and Family Welfare is Visual Inspection with Acetic Acid (VIA) every 5 years for women aged between 30 and 65 years. A significant improvement in terms of decreasing incidence and mortality of cervical cancer has been seen in two randomized controlled trials conducted in India. However, VIA lacks sensitivity, requires extensive training to be given to the medical staff for accurate diagnosis, has substantial operator variability and has less acceptability among women when compared to the newer methods of cervical cancer screening such as human papillomavirus (HPV) self-sampling. HPV self-sampling is a more sensitive, accurate and more acceptable method of cervical cancer screening for women in India and abroad. It can help the existing VIA-based strategy of cervical screening by increasing participation resulting in more population being screened in the various geographical regions and populations in India. However, VIA-based screening should also be continued because of its affordability and cost-effectiveness in India where there is a significant population belonging to low socio-economic background. There are numerous evidences such as systematic reviews, meta-analyses, randomised controlled trials of India and abroad that have been used as sources in this review article to come to the conclusion that HPV self-sampling is an acceptable, accurate and sensitive method that can be used as a primary screening tool in cervical cancer screening programmes globally and in India. It can also be used as an effective triage test for prioritising high-risk populations who require urgent and effective treatment for cervical pre-cancer and cancer. To conclude, HPV self-sampling should be integrated and implemented by the government and private sector in addition to VIA-based screening strategies for achieving the goal of cervical cancer elimination in India.
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人乳头瘤病毒自取样用于宫颈癌筛查:对印度国家筛查方案的接受、准确性、可行性和纳入情况的审查
除了疫苗接种策略外,筛查和治疗是消除宫颈癌的最重要工具。目前,印度缺乏一个全面的筛查计划。在该国现有子宫颈检查方案的可行性、可接受性和执行方面存在巨大问题。在印度,只有不到2%的妇女(城市-2.2%和农村-1.7%)接受过筛查。卫生和家庭福利部目前建议的战略是,对30至65岁的妇女每5年进行一次醋酸目视检查。在印度进行的两项随机对照试验显示,在降低宫颈癌发病率和死亡率方面取得了显著进展。然而,VIA缺乏敏感性,需要对医务人员进行广泛的培训才能进行准确的诊断,与人类乳头瘤病毒(HPV)自我抽样等较新的宫颈癌筛查方法相比,操作人员存在很大的可变性,妇女的接受度较低。对于印度和国外的妇女来说,HPV自采样是一种更敏感、更准确、更容易接受的宫颈癌筛查方法。它可以通过增加参与,从而使印度各地理区域和人口中更多的人口接受检查,从而帮助现有的基于via的子宫颈检查战略。然而,基于via的筛查也应继续进行,因为它在印度具有可负担性和成本效益,因为印度有大量人口属于低社会经济背景。有许多证据,如印度和国外的系统评价、荟萃分析、随机对照试验,已被用作本综述文章的来源,得出结论,HPV自采样是一种可接受的、准确的和敏感的方法,可作为全球和印度宫颈癌筛查规划的初级筛查工具。它也可以作为一种有效的分诊测试,优先考虑需要紧急和有效治疗宫颈癌前期和癌症的高危人群。总之,除了基于via的筛查策略外,政府和私营部门还应整合并实施HPV自我抽样,以实现印度消除宫颈癌的目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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