Background: The implementation of population screening for cervical lesions in rural areas has been particularly challenging for a variety of reasons, including geographic isolation, limited access to medical care, lack of awareness of cancer risks, lower education levels, and embarrassment about having the clinical examination. Methods: This study was designed to evaluate the use of self-sampling for human papillomavirus (HPV) screening in the rural communities served by our hospital. To develop the study group, we trained a local police officer who was already interacting with the rural community to explain cancer risks and the ease of self-sampling to the women. Results: We identified a study group of 386 women, of whom 369 (95.6%) agreed to participate in the study. To test for high-risk HPV, we performed the Cobas PCR test, and of 340 valid samples, 45 (12.2%) were positive for at least 1 of the high-risk HPV subtypes. All positively tested women were referred for colposcopy and Papanicolaou testing. The follow-up biopsies showed that 40% had low-grade intraepithelial neoplasia (CIN1), 6.6% had high-grade intraepithelial neoplasia (CIN2/3), and 4.4% had squamous cell carcinoma. Conclusions: Self-collection for HPV testing by women living in isolated communities is highly efficient and has potential for cost-effective screening by taking advantage of existing support networks, such as the local police service.

1.
(1)
Jemal
A
,
Bray
F
,
Center
MM
,
Ferlay
J
,
Ward
E
,
Forman
D
.
Global cancer statistics
.
CA Cancer J Clin
.
2011
Mar-Apr
;
61
(
2
):
69
90
.
[PubMed]
0007-9235
2.
Estimativa Inca
. “Incidência de câncer no Brasil [internet] (
2016
). Available in: http://www.inca.gov.br/estimativa/2016/estimativa-2016-v11.pdf
3.
International Agency for Research on Cancer
.
[). IARC.]
.
IARC Handb Cancer Prev
.
2005
;
10
:
•••
.1027-5622
4.
DiSaia
PJ
,
Creasman
WT
,
Mannel
RS
,
McMeekin
DS
,
Mutch
DG
.
Clinical Gynecologic Oncology E-Book
.
Elsevier Health Sciences
;
2017
.
5.
Walboomers
JM
,
Jacobs
MV
,
Manos
MM
,
Bosch
FX
,
Kummer
JA
,
Shah
KV
, et al
Human papillomavirus is a necessary cause of invasive cervical cancer worldwide
.
J Pathol
.
1999
Sep
;
189
(
1
):
12
9
.
[PubMed]
0022-3417
6.
Nieminen
P
,
Kallio
M
,
Anttila
A
,
Hakama
M
.
Organised vs. spontaneous Pap-smear screening for cervical cancer: A case-control study
.
Int J Cancer
.
1999
Sep
;
83
(
1
):
55
8
.
[PubMed]
0020-7136
7.
Mauad
E
,
Gomes
U
,
Melani
A
,
Morini
S
,
Denadai
M
.
Cervical cancer screening among urban Brazilian women
.
Cancer Detect Prev
.
2004
;
00
:
147
.0361-090X
8.
Mauad
EC
,
Gomes
UA
,
Nogueira
JL
,
Melani
AG
,
Lemos
DL
,
Hidalgo
GS
.
Prevention of cervical cancer in a poor population in Brazil
.
Fam Pract
.
2002
Apr
;
19
(
2
):
189
92
.
[PubMed]
0263-2136
9.
Goldie
SJ
,
Gaffikin
L
,
Goldhaber-Fiebert
JD
,
Gordillo-Tobar
A
,
Levin
C
,
Mahé
C
, et al;
Alliance for Cervical Cancer Prevention Cost Working Group
.
Cost-effectiveness of cervical-cancer screening in five developing countries
.
N Engl J Med
.
2005
Nov
;
353
(
20
):
2158
68
.
[PubMed]
0028-4793
10.
Sherris
J
,
Wittet
S
,
Kleine
A
,
Sellors
J
,
Luciani
S
,
Sankaranarayanan
R
, et al
Evidence-based, alternative cervical cancer screening approaches in low-resource settings
.
Int Perspect Sex Reprod Health
.
2009
Sep
;
35
(
3
):
147
54
.
[PubMed]
1944-0391
11.
Arbyn
M
,
Verdoodt
F
,
Snijders
PJ
,
Verhoef
VM
,
Suonio
E
,
Dillner
L
, et al
Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: a meta-analysis
.
Lancet Oncol
.
2014
Feb
;
15
(
2
):
172
83
.
[PubMed]
1470-2045
12.
Moses
E
,
Pedersen
HN
,
Mitchell
SM
,
Sekikubo
M
,
Mwesigwa
D
,
Singer
J
, et al
Uptake of community-based, self-collected HPV testing vs. visual inspection with acetic acid for cervical cancer screening in Kampala, Uganda: preliminary results of a randomised controlled trial
.
Trop Med Int Health
.
2015
Oct
;
20
(
10
):
1355
67
.
[PubMed]
1360-2276
13.
Ferreira
MD
.
Motivos que influenciam a não-realização do exame de Papanicolaou segundo a percepção de mulheres
.
Esc Anna Nery
.
2009
;
13
(
2
):
378
84
. 1414-8145
14.
Bosgraaf
RP
,
Ketelaars
PJ
,
Verhoef
VM
,
Massuger
LF
,
Meijer
CJ
,
Melchers
WJ
, et al
Reasons for non-attendance to cervical screening and preferences for HPV self-sampling in Dutch women
.
Prev Med
.
2014
Jul
;
64
:
108
13
.
[PubMed]
0091-7435
15.
Nelson
EJ
,
Maynard
BR
,
Loux
T
,
Fatla
J
,
Gordon
R
,
Arnold
LD
.
The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis.
Sex Transm Infect
2016
, sextrans-2016.
16.
Brasil. Ministério da Saúde (MS). Instituto Nacional de Câncer (Inca). Diretrizes brasileiras para o rastreamento do câncer do colo do útero
.
Rio de Janeiro
:
Inca
;
2011
.
17.
Watkins
MM
,
Gabali
C
,
Winkleby
M
,
Gaona
E
,
Lebaron
S
.
Barriers to cervical cancer screening in rural Mexico
.
Int J Gynecol Cancer
.
2002
Sep-Oct
;
12
(
5
):
475
9
.
[PubMed]
1048-891X
18.
Anhang
R
,
Nelson
JA
,
Telerant
R
,
Chiasson
MA
,
Wright
TC
 Jr
.
Acceptability of self-collection of specimens for HPV DNA testing in an urban population
.
J Womens Health (Larchmt)
.
2005
Oct
;
14
(
8
):
721
8
.
[PubMed]
1540-9996
19.
Khanna
N
,
Mishra
SI
,
Tian
G
,
Tan
MT
,
Arnold
S
,
Lee
C
, et al
Human papillomavirus detection in self-collected vaginal specimens and matched clinician-collected cervical specimens
.
Int J Gynecol Cancer
.
2007
May-Jun
;
17
(
3
):
615
22
.
[PubMed]
1048-891X
20.
da Silva
MRB
,
da Silva
LGP
.
Knowledge, attitudes and practice in the prevention of cervix cancer among basichealth unit west-RJ.
Journal of Research: Care is Fundamental Online
2012
; 4(3): 2483-2492.
21.
BRASIL
. Ministério do Desenvolvimento Social e Combate a Fome – MDS. Programa Brasil Sem Miséria. Brasília, 2012. Available in: http://bvsms.saude.gov.br/bvs/publicacoes/saude_brasil_2011.pdf. Access in: november
2017
.
22.
Fedrizzi
E
.
Epidemiology of genital HPV infection
.
Rev Bras Pat Trato Gen Inf
.
2011
;
1
(
1
):
3
8
.
23.
Ayres
AR
,
Silva
GA
.
Prevalence of cervical infection by HPV in Brazil: systematic review
.
Rev Saude Publica
.
2010
;
44
(
5
):
963
74
.
[PubMed]
0034-8910
24.
Facina
T
.
Estimate 2014 - Incidence of Cancer in Brazil
.
Rev Bras Cancerol
.
2014
;
60
(
1
):
63
4
.0034-7116
25.
Lorenzi
AT
,
Fregnani
JH
,
Possati-Resende
JC
,
Neto
CS
,
Villa
LL
,
Longatto-Filho
A
.
Self-collection for high-risk HPV detection in Brazilian women using the careHPV™ test
.
Gynecol Oncol
.
2013
Oct
;
131
(
1
):
131
4
.
[PubMed]
0090-8258
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