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Mexican Cervical Cancer Screening Study II: Acceptability of Human Papillomavirus Self-Sampler
  1. Lucybeth Nieves Arriba, MD, MPH*,
  2. Christine L. Enerson, MD,
  3. Suzanne Belinson, MPH, PHD,
  4. Loyd Novick, MD, MPH§ and
  5. Jerome Belinson, MD*,
  1. * Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland,OH;
  2. Prueba para la Vida, Michoacán, Mexico;
  3. Preventive Oncology International, Inc, Cleveland, OH; and
  4. § Department of Public Health, East Carolina University, Greenville, NC.
  1. Address correspondence and reprint requests to Jerome L. Belinson, MD, Preventive Oncology International, Inc, 2762 Fairmount Blvd, Cleveland Heights, OH 44118. E-mail: lucybethnieves{at}


Introduction: Cervical cancer is the second most common cancer in women worldwide. In countries like Mexico, cervical cancer early detection programs have had a minimal impact on the incidence and death rates from cervical cancer. Self-sampling for the presence of high-risk human papillomavirus is potentially a more effective screening tool to reach women who have limited access to community healthcare resources. The objective of this phase 2 trial was to establish if the fourth generation Preventive Oncology International/National Institutes of Health self-sampler device is well accepted by women of all socioeconomic levels in Michoacán, Mexico.

Methods: This is a prospective phase 2 trial. The patients used the self-sampler, and then the acceptability questionnaire (14 multiple choice questions) was completed with the assistance of nursing staff.

Results: Two thousand five hundred seventeen patients completed the questionnaire. The mean age of our patient population was 39 years. Eighty-six percent of patients reported being comfortable when using the self-test, and 76% preferred to do the test at the clinic. Ninety-one percent of patients said that if their only choice was to perform the test at home they would perform it rather than not perform the test. The major barriers for the use of self-sampler identified by the women in the study were fear (75%), women might not perform the test because she does not feel ill (70%), women felt that husbands may stand in women's way of performing the test (66%), and lack of time (61%). Results differed by location but not by history of Papanicolaou test.

Conclusions: Most patients reported being comfortable when using the Preventive Oncology International/National Institutes of Health fourth generation self-test. Most influential barriers identified by the acceptability questionnaire were fear, lack of signs or symptoms of illness, husbands' influence, cost, lack of time, being unable to read, and lack of trust in the medical community.

  • HPV
  • Self-sampling
  • Acceptability

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