Self-Collection Tools for Routine Cervical Cancer Screening: A Review

  • Published : 2014.11.06


Sub-optimal participation is a major problem with cervical cancer screening in developing countries which have no organized national screening program. There are various notable factors such as 'embarrassment', 'discomfort' and 'no time' cited by women as they are often also the bread winners for the family. Implementation of self-sampling methods may increase their participation. The aim of this article was to provide a survey of various types of self-sampling tools which are commonly used in collection of cervical cells. We reviewed currently available self-sampling devices and collated the advantages and disadvantages of each in terms of its acceptance and its accuracy in giving desired results. In general, regardless of which device is used, self-sampling for cervical scrapings is highly acceptable to women in most of the studies cited.


Supported by : Universiti Sains Malaysia


  1. Scarinci IC, Litton AG, Garces-Palacio IC, et al (2013). Acceptability and usability of self-collected sampling for HPV testing among African-American women living in the Mississippi Delta. Womens Health Issues, 23, 123-30.
  2. Sahasrabuddhe VV, Parham GP, Mwanahamuntu MH, et al (2012). Cervical cancer prevention in low- and middleincome countries: feasible, affordable, essential. Cancer Prev Res, 5, 11-7.
  3. Sanchaisuriya P, Pengsaa P, Sriamporn S, et al (2004). Experience with a self-administered device for cervical cancer screening by Thai women with different educational backgrounds. Asian Pac J Cancer Prev, 5, 144-50.
  4. Sancho-Garnier H, Tamalet C, Halfon P, et al (2013). HPV self-sampling or the Pap-smear: A randomized study among cervical screening nonattenders from lower socioeconomic groups in France. Int J Cancer, 133, 2681-7.
  5. Schmeink CE, Bekkers RL, Massuger LF, et al (2011). The potential role of self-sampling for high-risk human papillomavirus detection in cervical cancer screening. Rev Med Virol, 21, 139-53.
  6. Szarewski A, Cadman L, Mallett S, et al (2007). Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting. J Med Screen, 14, 34-42.
  7. Tamalet C, Le Retraite L, Leandri FX, et al (2013). Vaginal self-sampling is an adequate means of screening HR-HPV types in women not participating in regular cervical cancer screening. Clin Microbiol Infect, 19, E44-50.
  8. Yoshida T, Nishijima Y, Hando K, et al (2013). Primary study on providing a basic system for uterine cervical screening in a developing country: analysis of acceptability of selfsampling in Lao PDR. Asian Pac J Cancer Prev, 14, 3029-35.
  9. van Baars R, Bosgraaf RP, ter Harmsel BW, et al (2012). Dry storage and transport of a cervicovaginal self-sample by use of the Evalyn Brush, providing reliable human papillomavirus detection combined with comfort for women. J Clin Microbiol, 50, 3937-43.
  10. Wikstrom I, Lindell M, Sanner K, et al (2011). Self-sampling and HPV testing or ordinary Pap-smear in women not regularly attending screening: a randomised study. Br J Cancer, 105, 337-9.
  11. Wiley DJ, Hsu H, Bolan R, et al (2013). Comparison of 2 Anal Cytology Protocols to Predict High-Grade Anal Intraepithelial Neoplasia. J Low Genit Tract Dis, 17, 414-24
  12. Zehbe I, Moeller H, Severini A, et al (2011). Feasibility of selfsampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest Ontario, Canada: a pilot study. BMJ Open, 1, 000030.
  13. Lenselink CH, de Bie RP, van Hamont D, et al (2009). Detection and genotyping of human papillomavirus in self-obtained cervicovaginal samples by using the FTA cartridge: new possibilities for cervical cancer screening. J Clin Microbiol, 47, 2564-70.
  14. Lorenzato FR, Singer A, Ho L, et al (2002). Human papillomavirus detection for cervical cancer prevention with polymerase chain reaction in self-collected samples. Am J Obstet Gynecol, 186, 962-8.
  15. Moscicki AB, Widdice L, Ma Y, et al (2010). Comparison of natural histories of human papillomavirus detected by clinician- and self-sampling. Int J Cancer, 127, 1882-92.
  16. Othman N, Othman NH (2014). Detection of human papillomavirus DNA in routine cervical scraping samples: use for a national cervical cancer screening program in a developing nation. Asian Pac J Cancer Prev, 15, 2245-9.
  17. Nabandith V, Pholsena V, Mounthisone P, et al (2012). First trial of cervical cytology in healthy women of urban Laos using by self-sampling instrument. Asian Pac J Cancer Prev, 13, 4665-7.
  18. Nobbenhuis MA, Helmerhorst TJ, van den Brule AJ, et al (2002). Primary screening for high risk HPV by home obtained cervicovaginal lavage is an alternative screening tool for unscreened women. J Clin Pathol, 55, 435-9.
  19. Okayama K, Okodo M, Fujii M, et al (2012). Improved accuracy of cytodiagnosis using the Kato self-collection devise: the usefulness of smear preparation in liquid-based cytology methods. Asian Pac J Cancer Prev, 13, 4521-4.
  20. Othman NH, Devi BC, Halimah Y (2009). Cervical cancer screening: patients understanding in major hospitals in Malaysia. Asian Pac J Cancer Prev, 10, 569-74.
  21. Othman NH, Rebolj M (2009). Challenges to cervical screening in a developing country: The case of Malaysia. Asian Pac J Cancer Prev, 10, 747-52.
  22. Parsonnet J, Modern PA, Giacobbe KD (1996). Effect of tampon composition on production of toxic shock syndrome toxin-1 by Staphylococcus aureus in vitro. J Infect Dis, 173, 98-103.
  23. Pengsaa P, Sriamporn S, Kritpetcharat O, et al (2003). A comparison of cytology with Pap smears taken by a gynecologist and with a self-sampling device. Asian Pac J Cancer Prev, 4, 99-102.
  24. Piana L, Leandri FX, Le Retraite L, et al (2011). HPV-Hr detection by home self sampling in women not compliant with pap test for cervical cancer screening. Results of a pilot programme in Bouches-du-Rhone. Bull Cancer, 98, 723-31.
  25. Belinson JL, Qiao YL, Pretorius RG, et al (2003). Shanxi Province cervical cancer screening study II: self-sampling for high-risk human papillomavirus compared to direct sampling for human papillomavirus and liquid based cervical cytology. Int J Gynecol Cancer, 13, 819-26.
  26. Rashwan H, Lubis SH, Ni KA (2011). Knowledge of cervical cancer and acceptance of HPV vaccination among secondary school students in Sarawak, Malaysia. Asian Pac J Cancer Prev, 12, 1837-41.
  27. Richman AR, Brewer NT, Liebman AK, et al (2011). Optimising human papillomavirus self-testing for high risk women. Sex Transm Infect, 87, 118-22.
  28. Rositch AF, Gatuguta A, Choi RY, et al (2012). Knowledge and acceptability of pap smears, self-sampling and HPV vaccination among adult women in Kenya. PLoS One, 7, e40766.
  29. Bosgraaf RP, Ketelaars PJ, Verhoef VM, et al (2014a). Reasons for non-attendance to cervical screening and preferences for HPV-self-sampling in Dutch women. Prev Med, 64, 108-13.
  30. Bosgraaf RP, Verhoef VM, Massuger LF, et al (2014b). Comparative performance of novel self-sampling methods in detecting high-risk human papillomavirus in 30,130 women not attending cervical screening. Int J Cancer, 2014.
  31. Brink AA, Meijer CJ, Wiegerinck MA, et al (2006). High concordance of results of testing for human papillomavirus in cervicovaginal samples collected by two methods, with comparison of a novel self-sampling device to a conventional endocervical brush. J Clin Microbiol, 44, 2518-23.
  32. Cerigo H, Coutlee F, Franco EL, et al (2012). Dry self-sampling versus provider-sampling of cervicovaginal specimens for human papillomavirus detection in the Inuit population of Nunavik, Quebec. J Med Screen, 19, 42-8.
  33. Darlin L, Borgfeldt C, Forslund O, et al (2013). Vaginal selfsampling without preservative for human papillomavirus testing shows good sensitivity. J Clin Virol, 56, 52-6.
  34. Al-Naggar RA, Low WY, Isa ZM (2010). Knowledge and barriers towards cervical cancer screening among young women in Malaysia. Asian Pac J Cancer Prev, 11, 867-73.
  35. Baay MF, Verhoeven V, Lambrechts HA, et al (2009). Feasibility of collecting self-sampled vaginal swabs by mail: quantity and quality of genomic DNA. Eur J Clin Microbiol Infect Dis, 28, 1285-9.
  36. da Silva Rocha A, Schaeffer PG, Meurer L, et al (2012). Assessment of the Fournier (R) cervical specimen selfsampling device using the Papanicolaou method. Acta Cytol, 56, 520-6.
  37. Delany S, Rosas R, Mlaba N, et al (2008). Comparison of cervicovaginal lavage, cervicovaginal lavage enriched with cervical swab, and vaginal tampon for the detection of HIV-1 RNA and HSV-2 DNA in genital secretions. J Acquir Immune Defic Syndr, 49, 406-9.
  38. Delere Y, Schuster M, Vartazarowa E, et al (2011). Cervicovaginal self-sampling is a reliable method for determination of prevalence of human papillomavirus genotypes in women aged 20 to 30 years. J Clin Microbiol, 49, 3519-22.
  39. Dijkstra MG, Heideman DA, van Kemenade FJ, et al (2012). Brush-based self-sampling in combination with GP5+/6+- PCR-based hrHPV testing: high concordance with physiciantaken cervical scrapes for HPV genotyping and detection of high-grade CIN. J Clin Virol, 54, 147-51.
  40. Dixit S, Fischer G & Wittekind C (2013). Recurrent menstrual toxic shock syndrome despite discontinuation of tampon use: is menstrual toxic shock syndrome really caused by tampons? Australas J Dermatol, 54, 283-6.
  41. Forney LJ, Gajer P, Williams CJ, et al (2010). Comparison of self-collected and physician-collected vaginal swabs for microbiome analysis. J Clin Microbiol, 48, 1741-8.
  42. Dodge B, Van Der Pol B, Reece M, et al (2012). Rectal selfsampling in non-clinical venues for detection of sexually transmissible infections among behaviourally bisexual men. Sex Health, 9, 190-1.
  43. Dunn RA, Tan AK (2010). Cervical cancer screening in Malaysia: Are targeted interventions necessary? Soc Sci Med, 71, 1089-93.
  44. Eperon I, Vassilakos P, Navarria I, et al (2013). Randomized comparison of vaginal self-sampling by standard vs dry swabs for human papillomavirus testing. BMC Cancer, 13, 353.
  45. Forrest S, McCaffery K, Waller J, et al (2004). Attitudes to self-sampling for HPV among Indian, Pakistani, African-Caribbean and white British women in Manchester, UK. J Med Screen, 11, 85-8.
  46. Gok M, Heideman DA, van Kemenade FJ, et al (2012a). Offering self-sampling for human papillomavirus testing to non-attendees of the cervical screening programme: Characteristics of the responders. Eur J Cancer, 48, 1799-808.
  47. Gok M, van Kemenade FJ, Heideman DA, et al (2012b). Experience with high-risk human papillomavirus testing on vaginal brush-based self-samples of non-attendees of the cervical screening program. Int J Cancer, 130, 1128-35.
  48. Gravitt PE, Lacey JV, Jr., Brinton LA, et al (2001). Evaluation of self-collected cervicovaginal cell samples for human papillomavirus testing by polymerase chain reaction. Cancer Epidemiol Biomarkers Prev, 10, 95-100.
  49. Guan Y, Castle PE, Wang S, et al (2012). A cross-sectional study on the acceptability of self-collection for HPV testing among women in rural China. Sex Transm Infect, 88, 490-4.
  50. Howard M, Lytwyn A, Lohfeld L, et al (2009). Barriers to acceptance of self-sampling for human papillomavirus across ethnolinguistic groups of women. Can J Public Health, 100, 365-9.
  51. Gupta S, Sahdev A, Forsythe S, et al (1994). Tampon-induced toxic shock syndrome. Postgrad Med J, 70, 669.
  52. Harper DM, Hildesheim A, Cobb JL, et al (1999). Collection devices for human papillomavirus. J Fam Pract, 48, 531-5.
  53. Harper DM, Raymond M, Noll WW, et al (2002). Tampon samplings with longer cervicovaginal cell exposures are equivalent to two consecutive swabs for the detection of high-risk human papillomavirus. Sex Transm Dis, 29, 628-36.
  54. Jones HE, Allan BR, van de Wijgert JH, et al (2007). Agreement between self- and clinician-collected specimen results for detection and typing of high-risk human papillomavirus in specimens from women in Gugulethu, South Africa. J Clin Microbiol, 45, 1679-83.
  55. Karwalajtys T, Howard M, Sellors JW, et al (2006). Vaginal self sampling versus physician cervical sampling for HPV among younger and older women. Sex Transm Infect, 82, 337-9.

Cited by

  1. Prevalence of Cancers of Female Organs among Patients with Diabetes Type 2 in Kelantan, Malaysia: Observations over an 11 Year Period and Strategies to Reduce the Incidence vol.16, pp.16, 2015,
  2. Assessment of the Reliability of a Novel Self-sampling Device for Performing Cervical Sampling in Malaysia vol.16, pp.2, 2015,
  3. Knowledge, Attitudes and Practice about Pap Smear Test among Women Living in Bojnourd, North East of Iran: a Population-Based Study vol.16, pp.5, 2015,
  4. Comparative Assessment of a Self-sampling Device and Gynecologist Sampling for Cytology and HPV DNA Detection in a Rural and Low Resource Setting: Malaysian Experience vol.16, pp.18, 2016,
  5. Candidate biomarkers in the cervical vaginal fluid for the (self-)diagnosis of cervical precancer pp.1432-0711, 2017,