Home Screening for Human Papillomavirus Falls Short in Initial Application, Remains Promising
Mené aux Etats-Unis auprès de 19 851 femmes n'ayant subi aucun test Pap dans les 41 derniers mois (âge moyen : 50 ans), cet essai évalue, par rapport aux modalités de rappel utilisées habituellement par les centres de soins primaires et du point de vue de l'amélioration de la détection des lésions cervicales intraépithéliales de grade 2 ou supérieur, de l'augmentation du nombre de cas traités et du taux de participation aux examens de dépistage, l'efficacité d'une intervention consistant à envoyer au domicile un kit d'autoprélèvement vaginal pour test HPV
In their randomized clinical trial, Winer et al studied the effect of mailed human papillomavirus (HPV) self-screening kits vs usual care reminders on cervical cancer screening among underscreened women (ie, women whose last Papanicolaou test was more than 3.4 years before the intervention) in the Kaiser Permanente health care system. As the authors note, the challenges of increasing cervical cancer screening uptake are daunting, and overcoming those challenges has the potential to drastically reduce morbidity and mortality from cervical cancer. Given the barriers to in-clinic screening, the idea of home HPV testing to increase cancer prevention efforts is appealing. Although the intervention did not lead to a statistically significant increase in the primary outcomes of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) detection (relative risk, 1.49; 95% CI, 0.61-3.64) or treatment (relative risk, 1.70; 95% CI, 0.67-4.32), the intervention increased screening uptake (relative risk, 1.51; 95% CI, 1.43-1.60) and reduced the time to screening uptake (median [interquartile range] time to screening uptake: 37 [22-49] days vs 80 [43-129] days). While the trial is admirable in its design and large sample size, several limitations prevent it from having broad implications for cervical cancer screening at this time.
JAMA Network Open , commentaire en libre accès, 2018