The acceptability of a self-lavaging device compared to pelvic examination for cervical cancer screening among low-income women.
BACKGROUND
A simpler approach to cervical cancer screening could increase coverage, thus reducing cervical cancer mortality in the United States. Self-collection of specimens for screening tests may be one such approach. The aim of this study was to assess the acceptability of a self-lavaging device (Delphi Screener(™), Scherpenzeel, The Netherlands) for cervical cancer screening. Self-lavage specimens have been shown to have equivalent sensitivity for detection of high-grade cervical intraepithelial neoplasia (CIN) when coupled with high-risk human papillomavirus (HPV) tests as clinician-collected specimens with cytologic review.


METHODS
Low-income women (n=198) who had recently received cervical cytologic testing in one of three participating clinics in New York City enrolled; 197 self-lavaged. Women answered open-ended and closed-ended questions on ease of use, level of comfort with the self-lavage and the pelvic examination, and future screening preference.


RESULTS
Ninety-six percent of women reported they were very/somewhat comfortable self-lavaging compared to 47% very/somewhat comfortable with the clinician collecting a specimen during a pelvic examination (p<0.001). The majority (79%) would prefer self-lavage the next time they need to be screened; only 8% would prefer pelvic examination by a doctor, and 14% had no preference. The main reasons for preferring self-lavage centered on convenience and comfort.


CONCLUSIONS
Self-lavaging was highly acceptable to women in this study. Self-collection of specimens has the potential to simplify screening and reduce logistical barriers for many women, which could increase overall coverage of cervical cancer screening.
Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, New York, USA. hjon@hunter.cuny.edu
Heidi E
HE
Jones
Karen
K
Brudney
Dorothy J
DJ
Sawo
Rafael
R
Lantigua
Carolyn L
CL
Westhoff
D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000821:virology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007182:Income; D008875:Middle Aged; D009519:New York City; D010147:Pain Measurement; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods*; D012959:Socioeconomic Factors; D013048:Specimen Handling / Q000379:methods; D011795:Surveys and Questionnaires; D044364:Vaginal Douching; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology