Human papillomavirus detection for cervical cancer prevention with polymerase chain reaction in self-collected samples

Objective: We studied the usefulness of self-sampling in cervical cancer prevention. Study Design: A cross-sectional study was undertaken at screening services in Recife (Brazil); 253 women aged 16 to 88 years were included. Participants were randomly selected from a high-risk population for cervical neoplasia. All participants collected a self-sample with a cotton-tipped swab by rotating it against the vaginal epithelium and, possibly, the cervix. Physician-collected samples from the ectocervix and endocervix, respectively, with an Ayreʹs spatula and a Cytobrush endocervical brush (Medscand) were followed by thorough colposcopy. Human papillomaviruses were detected by consensus polymerase chain reaction and typed by restriction fragment length polymorphism. Results: The difference among human papillomavirus results in samples that were self-collected versus physician collected was significant (P< .03). The agreements were poor among patients with cervical intraepithelial neoplasia (CIN) grade 3 (κ <0.29) and cervical cancer (κ < 0.10). Self-sampling missed 50% more cancers than did physician sampling (P = .04). Conclusion: Self-sampling with a cotton-tipped swab for human papillomavirus detection is not a safe method for the collection of samples that are aimed at primary cervical cancer screening. (Am J Obstet Gynecol 2002;186:962-8.)