Academic Article,September 2025

HPV Self-Sampling: A New Option for Cervical Cancer Screening

National Cancer Institute

          Cervical cancer remains one of the leading causes of death among Thai women. The World Health Organization (WHO) estimates that over 300,000 women die from the disease annually worldwide(1). Persistent infection with high-risk human papillomavirus (HPV), a sexually transmitted virus, is the primary cause. While most infections clear spontaneously, some persist and progress to precancerous lesions and eventually cervical cancer. In Thailand, the national screening program currently relies on Pap smears and HPV DNA testing, with samples collected by healthcare professionals. However, participation remains lower than expected due to embarrassment, inconvenience, or lack of time. To address this, HPV self-sampling has been introduced, allowing women to collect their own samples privately and conveniently.

Results from HPV self-sampling are typically categorized into three groups:

• Negative for high-risk HPV: No high-risk HPV detected. Women can continue routine screening at recommended intervals (e.g., every 5 years).

• Positive for high-risk HPV: High-risk HPV detected. Further evaluation, such as cervical cytology or colposcopy, is required.

• Invalid/Unsatisfactory: Sample insufficient or technically problematic. Repeat sampling is needed.

It is important to note that HPV self-sampling is a screening tool; women testing positive require confirmatory assessment by gynecologists.

Accuracy and Effectiveness
          Multiple studies and systematic reviews confirm that HPV self-sampling provides sensitivity and specificity comparable to clinician-collected samples.

• A meta-analysis by Arbyn et al.(2) found that self-collected samples achieved sensitivity for detecting precancerous lesions (CIN2+) close to clinician-collected samples (>90%).

• A multicenter study in Thailand(3) reported 87% sensitivity for detecting CIN2+ lesions using self-collected samples.

Detection of CIN2+ lesions is crucial, as these are considered high-risk precancerous changes with significant potential to progress to cancer if untreated. Early detection enables prevention of invasive disease and mortality reduction.

Context in Thailand
        Research in Thailand indicates high acceptability of HPV self-sampling(4), especially among women facing barriers to conventional screening. Feasibility studies further suggest that this method can serve as a complementary strategy alongside clinician-based screening, expanding access to previously unscreened populations.
        The World Health Organization (WHO) has proposed the “Global Strategy to Accelerate the Elimination of Cervical Cancer”, which aims to ensure that by 2030 at least 70% of women worldwide undergo effective cervical cancer screening (1). The implementation of HPV self-sampling in Thailand therefore plays a crucial role as a complementary tool to enhance accessibility and to help the country move closer to achieving WHO’s target of eliminating cervical cancer.

HPV DNA Self-Test Screening Program in Thailand: this program is jointly implemented by the National Health Security Office (NHSO), the Department of Medical Services, Ministry of Public Health, and various healthcare facilities. Its main objectives are:

• To provide cervical cancer screening using HPV DNA testing for women aged 30–60 years, as well as women aged 15–29 years who are at high risk.

• To improve access to services by offering self-sampling kits for HPV testing, thereby reducing barriers related to time, inconvenience, and embarrassment.

Conclusion
          HPV self-sampling is an accurate, reliable, and highly acceptable alternative for cervical cancer screening. It holds strong potential to increase screening coverage, particularly among women who have never or rarely accessed facility-based services. To ensure effective national implementation, follow-up systems for HPV-positive results and cost-effectiveness assessments are essential. Integrating HPV self-sampling into national screening policy could accelerate progress toward cervical cancer elimination in Thailand.

References

1. Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11(2):e197-e206.

2. Phillips SA, Denoël S, Wentzensen N, Arbyn M. Accuracy of HPV self-collection compared to clinician-collected HPV testing and cytology: a meta-analysis. Cancer Epidemiol Biomarkers Prev. Published online July 11, 2025.

3. Phoolcharoen N, Areeruk W, Kantathavorn N, et al. Self- and physician-collected high-risk human papillomavirus (HPV) testing to detect high-grade cervical lesions among Thai women. Int J Gynecol Cancer. 2023;33(9):1354-1358.

4. Ploysawang P, Pitakkarnkul S, Kolaka W, et al. Acceptability and Preference for Human Papilloma Virus Self-Sampling among Thai Women Attending National Cancer Institute. Asian Pac J Cancer Prev. 2023;24(2):607-612.