Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting

Anne Szarewski, Louise Cadman, Susan Mallett, Janet Austin, Philip Londesborough, Jo Waller, Jane Wardle, Douglas G Altman, Jack Cuzick

Research output: Contribution to journalArticlepeer-review

60 Citations (Scopus)


OBJECTIVES: To compare the performance and acceptability of unsupervised self-sampling with clinician sampling for high-risk human papillomavirus (HPV) types for the first time in a UK screening setting.

SETTING: Nine hundred and twenty women, from two demographically different centres, attending for routine cervical smear testing.

METHODS: Women performed an unsupervised HPV self-test. Immediately afterwards, a doctor or nurse took an HPV test and cervical smear. Women with an abnormality on any test were offered colposcopy.

RESULTS: Twenty-one high-grade and 39 low-grade cervical intraepithelial neoplasias (CINs) were detected. The sensitivity for high-grade disease (CIN2+) for the self HPV test was 81% (95% confidence interval [CI] 60-92), clinician HPV test 100% (95% CI 85-100), cytology 81% (95% CI 60-92). The sensitivity of both HPV tests to detect high- and low-grade cervical neoplasia was much higher than that of cytology (self-test 77% [95%CI 65-86], clinician test 80% [95% CI 68-88], cytology 48% [95% CI 36-61]). For both high-grade alone, and high and low grades together, the specificity was significantly higher for cytology (greater than 95%) than either HPV test (between 82% and 87%). The self-test proved highly acceptable to women and they reported that the instructions were easy to understand irrespective of educational level.

CONCLUSIONS: Our results suggest that it would be reasonable to offer HPV self-testing to women who are reluctant to attend for cervical smears. This approach should now be directly evaluated among women who have been non-attenders in a cervical screening programme.

Original languageEnglish
Pages (from-to)34-42
Number of pages9
JournalJournal of Medical Screening
Issue number1
Publication statusPublished - 2007


  • Adult
  • Age Distribution
  • Aged
  • Algorithms
  • Cervical Intraepithelial Neoplasia
  • Female
  • Humans
  • Middle Aged
  • Papillomaviridae
  • Patient Acceptance of Health Care
  • Reference Standards
  • Self-Examination
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms
  • Vaginal Smears


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