2024-01-19 13:52:25
January 19, 2024
National screening for cervical cancer, attributable in almost 100% of cases to papillomavirus (HPV) infection, is aimed at all women aged 25 to 65. But, when only 60% of women are screened, how can we reach the remaining 40% of women? To respond to this public health issue, self-sampling will soon be integrated into screening campaigns.
Every year in France, 3,000 women develop cervical cancer and nearly 1,000 die from it. To reduce the incidence of this cancer, the fourth most common cancer in women worldwide, organized screening for cervical cancer is offered to women aged 25 to 65. This aims to increase screening coverage to reach 80% of women and reduce the incidence and mortality of cervical cancer by 30%. However, still 40% of targeted women do not get screened. The reasons are diverse: distance from care, fear of the doctor, modesty, etc.
How can we successfully reach these women? Self-debiting might be part of the answer. “We know today, thanks to various studies, that self-sampling makes it possible to reach women who do not get screened. The patient manages her sample herself and is not subject to examination by a health professional. confirms Professor Xavier Carcopino, president of the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV). “When we offer this test, we increase screening coverage. »
For women aged 30 and over
Thus, according to the recommendations of the HAS in 2021, confirmed in 2022 by the National Cancer Institute (INCA) in its national framework, “vaginal self-sampling must be offered, from the age of 30, to unscreened or insufficiently screened women. This is an alternative method to sampling carried out by a clinician.”
Concretely, how will the system be implemented (in the coming months, according to the SFCPCV)? A self-sampling kit will be sent to women aged 30 and over by the regional screening coordination centers, 12 months following the first invitation letter. If the patient is eligible, the healthcare professional who follows her can also make a request for her patient. She will receive the kit with an accompanying letter.
The instructions for use are simple. This is a swab, a sort of large cotton swab, to be inserted into the vagina. You must then turn it three times while touching the walls. Then put the cotton swab back in the tube to insert into a duly labeled plastic pouch and post quickly to the laboratory, with the identification sheet. “We know that the sensitivity of these tests is, roughly speaking, the same as the tests carried out by health professionals”, affirms Professor Carcopino.
An HPV test, but not a cytological examination
The self-debit limit? “This test does not allow cytology, what we called before the smear, the examination of flaking cervical cells, aimed at identifying, or not, abnormal cells. Self-sampling allows collection of vaginal secretions but does not allow sampling from the cervix. explains the president of the SFCPCV. This self-sampling only allows an HPV test to be carried out, as papillomaviruses are the cause of almost 100% of cervical cancers.
When a sample is taken by a healthcare professional, if the HPV test is positive, the laboratory carries out the cytological examination from the same sample. With self-debit, this is not possible. If the test is positive for HPV, the patient will need to see a healthcare professional to take a sample in order to carry out the cytological examination. Will these women who do not participate in screening make an appointment for a sample? “According to our studies, we are generally below 50% of patients who consult following a positive HPV test. But it still remains a good way to identify populations and then go looking for them,” notes Xavier Carcopino. Useful, in addition, for women who agree to consult. If the test is negative, the patient has nothing to do for the next five years.
Another limit according to the specialist: “if the test is positive, these women do not benefit from information from a professional even though we know that the announcement of a positive test is a source of great anxiety.”
To note : self-debit is not offered to women before the age of 30 “because the possibility that it is positive for HPV is too great”, specifies Professor Carcopino. It is also for this reason that organized screening is carried out by cytological examination in women aged 25 to 29 (two examinations one year apart then 3 years later, if the results are normal). From the age of 30, screening consists of an HPV test every 5 years, therefore aiming to detect high-risk HPV viruses.
Source: National reference, cervical cancer screening, framework and methods for using vaginal self-samples, Inca – Press conference of the French Society of Colposcopy and Cervico-Vaginal Pathology, January 11 – Public Health France – Ameli.fr.
Written by: Dorothée Duchemin – Edited by Emmanuel Ducreuzet
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