An Implementation Tool For US Professionals: First Void Urine Self-Sampling for Primary HPV Cervical Cancer Screening

The national coverage of cervical cancer screening in the US is falling, with about 1 in 4 women not up to date with screening¹. Under-screened women bear the greatest burden of disease. Evidence shows 60-64% of American women diagnosed with cervical cancer were unscreened, highlighting the need to explore alternative methods to improve access^2-4.

In the US, as with elsewhere, self-sampling for HPV primary cervical screening has the potential to increase access to screening in under screened groups. Evidence supports self-sampling as an acceptable, safe and reliable modality for specimen collection⁵. Self-collection of first-void urine (the first part of the urine stream, collected at any time of the day) has some advantages for HPV primary based screening, since it is non-invasive and easy to collect using a urine collection device. First-void urine contains higher concentrations of HPV DNA than subsequent void fractions and is therefore optimal for HPV screening⁶.

Healthcare professionals (HCPs) and providers who want to evaluate and promote the use of self-sampling for screening in their patient population can face barriers to introducing self-collection. To address this, we developed an implementation tool (a series of questions within key themes) to enable HCPs and providers to become active stakeholders in improving access to HPV primary screening by identifying opportunities for first-void-urine self-sampling. The tool was refined and validated with three US-based subject matter experts from different professions related to cervical cancer and HPV screening.

Whilst piloting the tool, the subject matter experts stated socioeconomic status and lack of insurance as two key characteristics associated with reduced screening. Other barriers include cultural differences, lack of education on available services and the importance of screening and medical distrust. Understanding the benefits of first-void was identified as a barrier among HCPs. Many HCPs are not aware of urine-based self-sampling and will not have the same understanding of the definition of “first-void”.

The tool provides a starting point to enable US HCPs working in women’s health to be active stakeholders in shaping how HPV primary cervical cancer screening programs are designed and implemented to optimise access, early detection and prevention. This framework can be further adapted for use by other stakeholders, geographies, and healthcare systems. More education is needed on the benefits of self-sampling to address unmet need in cervical cancer screening and a clear definition of “first-void-urine” will reduce confusion.

The implementation tool can be downloaded here. The poster reporting this work will be presented at the IPVC conference in November 2024.

The poster can be found here.

References

1. Sabatino SA, Thompson TD, White MC, Villarroel MA, Shapiro JA, Croswell JM, et al. Up-to-Date Breast, Cervical, and Colorectal Cancer Screening Test Use in the United States, 2021. Prev Chronic Dis. 2023 Oct 26;20:E94
2. Benard VB, Jackson JE, Greek A, Senkomago V, Huh WK, Thomas CC, et al. A population study of screening history and diagnostic outcomes of women with invasive cervical cancer. Cancer Med. 2021 May 21;10(12):4127–37.
3. Landy R, Mathews C, Robertson M, Wiggins CL, McDonald YJ, Goldberg DW, et al. A state-wide population-based evaluation of cervical cancers arising during opportunistic screening in the United States. Gynecol Oncol. 2020 Nov;159(2):344–53.
4. Pruitt SL, Werner CL, Borton EK, Sanders JM, Balasubramanian BA, Barnes A, et al. Cervical Cancer Burden and Opportunities for Prevention in a Safety-net Healthcare System. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2018 Dec;27(12):1398–406.
5. Arbyn M, Castle PE, Schiffman M, Wentzensen N, Heckman-Stoddard B, Sahasrabuddhe VV. Meta-analysis of agreement/concordance statistics in studies comparing self- vs clinician-collected samples for HPV testing in cervical cancer screening. Int J Cancer. 2022 Jul 15;151(2):308-312. doi: 10.1002/ijc.33967.
6. Poljak M, Cuschieri K, Alemany L, Vorsters A. Testing for Human Papillomaviruses in Urine, Blood, and Oral Specimens: An Update for the Laboratory. J Clin Microbiol. 2023 Aug 23;61(8):e0140322. doi: 10.1128/jcm.01403-22. Epub 2023 Jul 13.

Citation for the poster