title: HPV self-sampling in Japanese women: A feasibility study in a population with limited experience of tampon use.
abstract: Cervical cancer incidence and mortality is increasing in Japanese women under age 50. Screening uptake is low and proactive recommendations for human papillomavirus vaccination have been suspended. Other cervical cancer prevention initiatives are urgently needed. We assessed whether human papillomavirus self-sampling might be an acceptable alternative to physician-led screening, particularly in women with limited experience of tampon use. We also sought to identify any practical, logistical, or safety issues in women already attending for screening, before carrying out further large-scale studies in non-responders.
  
  
  
  In total, 203 women aged 20-49 attending their annual workplace healthcheck in Sapporo, northern Japan, performed unsupervised human papillomavirus self-sampling before undergoing a physician-led cervical smear and human papillomavirus test, and completing a measure of acceptability for both tests.
  
  
  
  Ninety per cent of participants stated they would use self-sampling again. They found instructions easy to follow and reported no issues with the usability of the self-sampling device. Compared with physician-led testing, women found self-sampling significantly less painful, less embarrassing and could relax more (p < 0.001), regardless of history of tampon use, which was associated with negative experiences in physician sampling (p = 0.034). Women lacked confidence the test had been performed correctly, despite no unsatisfactory samples. No safety issues were reported.
  
  
  
  Self-sampling was highly acceptable in this population of women. They could perform the test safely unsupervised, but lacked confidence the test has been carried out correctly. Japanese women need to be educated about the accuracy of human papillomavirus self-sampling and further large-scale studies are necessary in non-responders.
authors.affiliation: Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan sjbh1810@med.hokudai.ac.jp.
authors.forename: Sharon Jb
authors.initials: SJ
authors.lastname: Hanley
authors.affiliation: Cytology Center, Hokkaido Cancer Society, Sapporo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Fujita
authors.affiliation: Sapporo Industrial Health Management Screening Center, Sapporo, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Sapporo Industrial Health Management Screening Center, Sapporo, Japan.
authors.forename: Shiori
authors.initials: S
authors.lastname: Kunisawa
authors.affiliation: Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamakoshi
authors.affiliation: Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Peixin
authors.initials: P
authors.lastname: Dong
authors.affiliation: Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Watari
authors.affiliation: Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kudo
authors.affiliation: Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan Department of Reproductive Endocrinology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakuragi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007564:Japan; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods*; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology; D010342:Patient Acceptance of Health Care; D012648:Self Care; D013048:Specimen Handling; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
keywords: Cervical cancer; acceptability; human papillomavirus self-sampling; screening; tampon use