title: Human papillomavirus detection for cervical cancer prevention with polymerase chain reaction in self-collected samples.
abstract: OBJECTIVE
  We studied the usefulness of self-sampling in cervical cancer prevention.
  
  
  METHODS
  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 Ayre's 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 (kappa <0.29) and cervical cancer (kappa < 0.10). Self-sampling missed 50% more cancers than did physician sampling (P =.04).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Instituto Materno Infantil de Pernambuco, Brazil. lorenzato@br.inter.net
authors.forename: Felipe R
authors.initials: FR
authors.lastname: Lorenzato
authors.forename: Albert
authors.initials: A
authors.lastname: Singer
authors.forename: Linda
authors.initials: L
authors.lastname: Ho
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Santos
authors.forename: Raimundo de Lucena
authors.initials: Rde L
authors.lastname: Batista
authors.forename: Telma M
authors.initials: TM
authors.lastname: Lubambo
authors.forename: George
authors.initials: G
authors.lastname: Terry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D010820:Physicians; D016133:Polymerase Chain Reaction; D012648:Self Care; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*