Balancing test accuracy with accessibility and acceptanceGlobally, cervical cancer affects more than 660 000 individuals and is responsible for 350 000 deaths each year.1 To detect early, more treatable precancerous lesions, the World Health Organization (WHO) recommends human papillomavirus (HPV) DNA detection as the primary cervical cancer screening test.2 Screening programmes can only reduce disease risk among individuals who participate. In England, cervical screening using clinician sampled HPV testing with cytology is offered to women aged 25 to 64 years, with coverage of 67.5% (25-49 years) and 74.9% (50-64 years), both lower than the performance threshold of 80%.3 4 5 6 Coverage is substantially lower in low and middle income countries, where the burden of cervical cancer is highest.7 In the US, more than half of Americans with a diagnosis of cervical cancer were overdue for screening, and such individuals are more likely to present with regionally advanced or metastatic disease, increasing the mortality risk.8HPV testing can be performed from self-collected specimens such as cervicovaginal brush or vaginal swab samples, both with comparable sensitivity and specificity to clinician collected samples.9 In clinical trials, self-sampling strategies increased screening participation and were cost effective.10 11 Multiple …
