Self Collection of HPV Samples Promotes Early Screening for Cervical Cancer

A study conducted by researchers at the Johns Hopkins School of Public Health, Makerere University and Columbia University has shown that women who live in poor rural areas of Africa can potentially benefit from the self-collection of vaginal samples to screen for humanpapilloma viruses (HPVs) that cause cervical cancer. In the past, many of these women were not screened because they did not have access to health care personnel, screening services and facilities. Also, cultural inhibitions often keep asymptomatic women from getting a routine pelvic exam. The study appears in the October 1999 issue of The Journal of Infectious Diseases.

Senior author Ronald Gray, MD, MSc, professor, Population and Family Health Sciences, Johns Hopkins School of Public Health, said, "Cervical cancer is a major public health problem in developing countries because of the lack of an adequate screening process for women. Also, the HIV epidemic has increased the prevalence of HPV infection and is associated with an increased incidence of cervical cancer. Finding a way to detect HPV early will allow us to identify women at risk of cervical cancer." In fact, sub-Saharan Africa has the highest rates of both HIV and cervical cancer in the world. Recent pilot studies have proven self-collection methods are as effective in detecting HPV as a physician's pelvic exam.

The study, a community-based randomized trial to test whether controlling sexually transmitted diseases (STDs) would help prevent HIV infection, took place in rural Uganda. Vaginal samples were provided by 737 consenting women ages15 to 59. All interviews and sample collections were conducted in the home to maximize compliance and coverage. The women were instructed to insert cotton-tipped swabs into the vagina to collect samples. Theswab specimens were immediately given to a field worker who sent them to Johns Hopkinsfor HPV testing. The women also provided a blood sample for HIV testing.

The results suggested that HPV infection, which can lead to cervical cancer, was highly prevalent in younger women but declined markedly with age in HIV-negative women. HPV infection in women over the age of 30, however, was common among HIV-positive subjects. Of the 737 women participating, 120 (16.3%) tested positive for HPV and 131 (17.8%) were infected with HIV-1. Only 10.2% of the women who were HIV-negative tested positive for HPV. However, of the 131 HIV-positive women, 44.3 % tested positive for HPV. The study also found that young HIV-positive women ages 15-29 years had the highest rates of HPV shedding in the genital tract.

Because self-collection of vaginal samples for HPV detection was acceptable to women in a rural African setting, the researchers plan to continue to study this approach to HPV detection. The connection between HPV prevalence and HIV infection shows the possibility that the HIV epidemic may be promoting a secondary epidemic of HPV and of cervical cancer.