Menstrual pad, a cervical cancer screening tool, a population-based study in rural India.

In the rural areas of India, women generally use a piece of old cloth as a menstrual device. The aim of this study was to detect human papilloma virus (HPV) from menstrual blood on the menstrual pad and assess whether this could be a useful screening tool for cervical cancer. In Jamkhed area of rural Maharashtra, (population A), we collected menstrual pads from women who provided consent in the 30-50 year age group. The women who had provided menstrual pads underwent HC2 testing. We standardized the method for extracting DNA by PCR from the menstrual pad. The women who tested HPV positive, on the basis of HC2/PCR testing, underwent colposcopy. In the rural population of Pune area of Maharashtra state (population B), menstrual pads were collected. HPV was tested using the PCR method. HPV-positive women and a few HPV-negative women, selected randomly, underwent colposcopy and HC2 testing. In population A, 164 women provided their used menstrual pads and also underwent an HC2 screening test. Of these, six (3.2%) cases were reported as HPV positive. In population B, 365 women provided their used menstrual pads for HPV testing, of which 18 (4.9%) cases were diagnosed as HPV positive. The women who tested HPV positive, on the basis of PCR testing, and 10% randomly selected HPV-negative cases (37) and 18 women who voluntary requested testing underwent colposcopy and HC2 testing. The sensitivity of menstrual pad HPV testing compared with gold standard HC2 testing was 83% [95% confidence interval (CI): 0.47-0.97], 67% (95% CI: 0.30-0.91) and specificity was 99% (95% CI: 0.96-0.99), 88% (95% CI: 0.77-0.94) in population A and population B, respectively. The sensitivity of diagnosing CIN lesion was 83% (95% CI: 0.44-0.97) and specificity was 95% (95% CI: 0.91-0.97). On the basis of the sensitivity and specificity results, and the completely noninvasive, simple and convenient method of detecting HPV, menstrual pad might be considered a cervical cancer screening tool in rural Indian women.

A prospective double-blind cross-sectional study of the accuracy of the use of dry vaginal tampons for self-sampling of human papillomaviruses.

OBJECTIVE: To evaluate if a dry vaginal tampon can be used to accurately detect high-risk human papillomaviruses (HPV) and so be used as a cervical screening tool for the early detection of high-grade cervical intraepithelial neoplasia (CIN2+). DESIGN: Prospective double-blinded cross-sectional study. SETTING: Colposcopy unit in North London. POPULATION: Women referred for colposcopy with both abnormal and normal cervical cytology were invited to participate in this study. METHODS: Women inserted a dry tampon in the vagina before colposcopic examination. Polymerase chain reaction (PCR) HPV test was carried out on the dry tampon. Cervical samples were collected by the colposcopist for HPV testing using Hybrid Capture (an HC2 kit). MAIN OUTCOME MEASURE: Detection of CIN2+. RESULTS: In all, 501 women participated in the study. The majority of participants (69%) were in the 25-35-year age group. Overall sensitivity and specificity for detection of CIN2+ by vaginal tampon were 76% (95% confidence interval [95% CI] 65-85) and 61% (95% CI 56-66), respectively, and HC2 had a sensitivity of 92% (95% CI 83-97) with a specificity of only 46% (95% CI 41-51). Sensitivity ratio was 0.83 (95% CI 0.73-0.94) (P = 0.004) and Specificity ratio for CIN2+ was 1.33 (95% CI 1.22-1.45). Indicating that the tampon test was significantly (P < 0.0001) more specific. Sensitivity decreased and specificity improved with increasing age. CONCLUSIONS: Dry tampon test showed reasonably high sensitivity and specificity when detecting CIN2+. The majority of participants (98%) approved of the use of dry tampons as a method of sample collection, which could be an effective alternative method for detecting HPV infection.

Cervical samples dried on filter paper and dried vaginal tampons can be useful to investigate the circulation of high-risk HPV in Congo.

BACKGROUND: High-risk HPV (HR-HPV) are associated with the development of cervical cancer, the most common cancer in women in developing countries. Reliable diagnosis of HR-HPV infection combined with simple procedures to collect and store biological samples, could improve primary screening programs and vaccine strategies in these areas. OBJECTIVE: To evaluate HR-HPV detection in conventional and dried samples. STUDY DESIGN: The presence of HR-HPV in 31 women in Republic of Congo (Central Africa) has been investigated by using standard cervical samples and dried cervical samples collected on filter paper and vaginal tampons. The detection of HPV DNA was performed in the Laboratory of virology in Lille (France) by using Hybrid capture 2 and HPV 16/18/45 Probe Set Test. RESULTS: 22 standard samples were found positive for the detection of HR-HPV (71%). HPV 16/18/45 was displayed in 15 out of 22 samples positive for HR-HPV (68%). The correlations between HPV detection by using standard samples and samples dried on filter paper and dried tampons were 90.3% (kappa = 0.77) and 80.6% (kappa = 0.5) respectively. The sensitivity and the specificity of HPV detection reached 91% and 89%, respectively, with samples dried on filter paper and were 86% and 67%, respectively, for dried tampons compared with standard samples. CONCLUSION: Dried cervical samples and dried vaginal tampons can represent an alternative to conventional sampling to reduce barriers to large screening programs in developing countries and to facilitate storage and transport to reference centers.