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Self-Testing Could Identify Marginalized Women With High-Risk HPV: Study

Posted on: Monday, 27 August 2007, 18:17 CDT

By SHERYL UBELACKER

TORONTO (CP) - Programs that would allow marginalized women with poor access to health-care to self-test for human papillomavirus could identify those at high risk for developing cervical cancer from the viral infection, a study suggests.

In a study published in Tuesday's edition of the Canadian Medical Association Journal, B.C. researchers found that women living in Vancouver's Downtown Eastside were amenable to self-collection kits to test for human papillomavirus (HPV), the major cause of cervical cancer.

The majority of the 151 women taking part in the research had either never had a Pap smear to screen for cervical cancer or had not had one in the three years previous to the study, far below the average for the province's general population.

Forty-three of the women were found to have an active infection with a high-risk strain of HPV, a sexually transmitted disease that can also cause genital warts.

"Certain groups of women don't attend for Pap smears even in a country like Canada, where there's universal health care," said lead author Dr. Gina Ogilvie, associate director in the division of sexually transmitted disease prevention at the B.C. Centre for Disease Control.

Ogilvie said these groups may include homeless women as well as those with stable housing but low socioeconomic status, the poorly educated and recent immigrants. Among those living in Vancouver's Downtown Eastside are women involved in the sex trade and illicit drug use.

Often, these marginalized women have difficulty accessing health-care services, Ogilvie said Monday from Vancouver. "One of the results of that is you tend to see higher rates of cervical cancer in some specific groups."

However, providing self-testing kits to women in the community would allow public health workers to identify those at increased risk of cervical cancer - and the study suggests such a program would be acceptable and feasible, Ogilvie noted.

To conduct the study, a team of outreach nurses who have long worked in the community supplied women with a kit that includes a cotton swab-like device for insertion in the vagina. The swab is then stored in a sterile collection tube and taken for analysis.

"What we're doing is not a Pap," said Ogilvie. "A Pap is where you actually look at the quality of cells from a certain part of the cervix. What we're actually doing with this is looking for an infection."

There are more than 100 strains of HPV and typically the body clears the infection with no lasting effects. But in some cases - and with certain strains - the virus may infiltrate cervical cells and eventually cause cancer. (About 400 women in Canada die each year from the disease.)

With the use of self-testing kits, women with potentially cancer-causing HPV infections can be pinpointed and sent for Pap screening - as well as other health care, said Ogilvie.

"It's an opportunity to capture women right when they're there," she said. "So if they're at a women's centre, they come in to have a coffee, you say: 'Can you just go to the bathroom and provide a sample?"'

"You can offer it where the women are."

Nurses were able to track down more than 80 per cent of those women who tested positive for high-risk HPV and refer them for further cervical cancer screening. (The study did not provide data on any cases of cervical cancer diagnosed among participants.)

More evaluation is needed, but if deemed effective as a public health tool, Ogilvie said she could envisage self-testing regimens integrated "as yet another element" of publicly funded cervical cancer screening programs across Canada.

Source: Canadian Press

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