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Assessing the feasibility of a rapid, high-volume cervical cancer screening program using HPV self-sampling and digital colposcopy in rural regions of Yunnan, China

Citation

Goldstein, Andrew et al. (2020), Assessing the feasibility of a rapid, high-volume cervical cancer screening program using HPV self-sampling and digital colposcopy in rural regions of Yunnan, China, Dryad, Dataset, https://doi.org/10.5061/dryad.8w9ghx3gr

Abstract

Objective: Implementation of a novel, rapid, high-volume, see-and-treat cervical cancer screening program utilizing self-swab HPV testing and digital colposcopy in underserved regions of Yunnan China.

Design: 500-1000 women per day self-swabbed for high-risk HPV (hrHPV+). Four careHPVTM machines (Qiagen) were run simultaneously to test the specimens. All hrHPV+ patients were contacted the same day and digital colposcopy (DC) was performed with the EVA system (MobileODT). Digital images were obtained, and all suspected lesions were biopsied and then treated.

Setting: Rural and underserved areas of the Yunnan province, Kunming municipality.

Participants: 3600 women, mean age 50.2 years, who had never been screened for cervical cancer.  The women were of the Yi, Hui, Dai, and Han ethnicities.

Interventions: Cryotherapy was performed on all lesions suspicious for CIN1 and LEEP was performed on all lesions suspicious CIN2+. ECC was performed if the transformation zone was not fully visualized.

Results: 216 women (6%) were hrHPV+. 168 underwent same-day colposcopy (23 CIN1, 17 CIN2+). DC was able to identify 15 of 16 (93.8%) CIN2+ lesions.

Conclusions: Currently, China does not have national screening guidelines or services for cervical cancer. Only 20.7% of Chinese women reported having ever been screened.

This study illustrates a cost- effective, rapid and practical strategy that can be used to screen-and-treat 400+ million Chinese women for cervical cancer. First, HPV self-sampling allows large numbers of women to be screened rapidly and inexpensively and only +hrHPV women require further evaluation. Digital colposcopy is then performed on +hrHPV women with a portable digital colposcope. The high-resolution images obtained during DC then facilitates appropriate same-day treatment as they are able to accurately distinguish between CIN1 and CIN2+ lesions.  Additionally, DC adds little to the time and cost of screening and produces permanent images that can be used for documentation, quality control, and expert consultation via a secure cloud-based portal.