The Utility of Urine-Based Sampling for Cervical Cancer Screening in Low-Resource Settings

Document Type: Research Articles

Authors

1 Manipal Institute of Virology, Manipal Academy of Higher Education (Deemed to be University), Manipal, Karnataka, India.

2 Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Government Medical College, Kozhikode, Kerala, India.

3 Department of Obstetrics and Gynecology, Government Medical College, Kozhikode, Kerala, India.

4 Department of Radiation Oncology, Government Medical College, Kozhikode, Kerala, India.

5 Department of Statistics, Prasanna School of Public health, Manipal Academy of Higher Education, Karnatka, India.

Abstract

Background: WHO has recommended Visual Inspection with Acetic acid (VIA) or Human Papillomavirus (HPV)
DNA testing if feasible, for cervical cancer screening in low income countries. However, the number of women
undergoing screening is very low as a result of limited information, inadequate infrastructure and invasive nature of
sampling. Methods: A cross sectional study was carried out comparing HPV DNA detection by Polymerase Chain
Reaction (PCR) in paired cervical and urine samples procured from histologically confirmed cervical cancer cases.
Results: Amongst the samples collected from 114 cervical cancer cases, HPV DNA was tested positive in cervical
samples of 89 (78.1%) and urine samples of 55 (48.2%) patients. The agreement between the two sampling methods
was 66.7% and the kappa value was 0.35 indicating a fair agreement. The sensitivity of HPV detection using urine
samples was 59.6% (95% confidence interval 49.16%-69.15%) and the specificity was 92% (95% confidence interval
75.0%-97.8%). Conclusion: Even though not acceptable as an HPV DNA screening tool due to low sensitivity, the
urine sampling method is inexpensive and more socially acceptable for large epidemiological surveys in developing
countries to estimate the burden.

Keywords

Main Subjects