Prevalence of Human Papilloma Virus Infection from Self-collected Sample versus Healthcare Providers-collected Sample for Cervical Cancer Screening at Loei Hospital: A Retrospective Descriptive Study

Abstract

Background and Objective: Cervical cancer is the most common gynecologic malignancy, ranking 4^th among cancers in women worldwide and 5^th among cancer-related causes of death in Thai women. This study aimed to compare the prevalence of high-risk human papillomavirus (HR-HPV) detection and cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) between self-collected and healthcare provider-collected samples among women undergoing cervical cancer screening.

Methods: A retrospective descriptive study included Thai women aged 30 to 60 years who underwent cervical cancer screening using HPV DNA testing in Mueang Loei District, Loei Province, Thailand, between 1^st January and 31th December 2024. Data were retrieved from the Loei Hospital database. Exclusion criteria included a history of hysterectomy, previous diagnosis of cervical cancer, prior pelvic radiotherapy, previous loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC), presence of a visible cervical mass, and pregnancy at the time of screening. A total of 2,898 women met the eligibility criteria, comprising 1,827 women in the healthcare provider-collected group and 1,071 women in the self-collected group. Women who tested positive for HPV types 16 or 18, or for other HR-HPV types in combination with abnormal cytology results of atypical squamous cells of undetermined significance (ASC-US) or worse, were referred for colposcopic examination and cervical biopsy for histopathological confirmation.

Results: HR-HPV was detected in 242 women (8.35%): 9.24% in the self-collected group and 7.83% in the healthcare providers-collected group (OR 1.20; 95% CI 0.92–1.57). Non-16/18 HPV types were most common (67.13%), followed by type 16 (20.28%) and type 18 (6.99%). Among those with non-16/18 HPV types who received cytology test, ASC-US or worse occurred in 37.50%. Women who underwent colposcopy, CIN2+ was found in 47.06% of the healthcare providers-collected group and 33.33% of the self-collected group, 35 cases of precancers and 3 cases of cervical cancers (2 cases stage IA1, 1 case stage IB2). In multivariable logistic regression, sampling method was not significantly associated with HR-HPV detection (adjusted OR=1.20; 95% CI 0.92–1.57; p=0.182), while age 40 years and older showed a statistically significant decreased risk of HR-HPV detection.

Conclusion: The prevalence of HR-HPV infection and CIN2+ did not differ significantly between self-collected and healthcare providers-collected sampling.