Comparison of Cervical Screening at 6- and 12-Weeks Postnatal: A Paired-Sample Feasibility Study

Abstract

Objective: Feasibility of a paired-sample study comparing cervical screening and urine self-sampling at 6- and 12-weeks postnatal.

Design: Paired-sample feasibility study.

Setting: Acute hospital.

Population or sample: Females within 6 weeks of childbirth.

Methods: Paired-sample study comparing cervical screening and high-risk human papillomavirus (HPV) testing from clinician-taken samples and urine self-samples at 6- and 12-weeks postnatal.

Main outcome measures: Uptake rates, patient-reported outcomes, adverse events, HPV detection, relative HPV sensitivity and specificity.

Results: Of 245 potential participants, 115 (47%) consented, 102 (89%) and 96 (83%) attended their 6- and 12-week screening visits, respectively. Median pain scores for cervical screening did not differ (6-weeks = 1; 12-weeks = 1; p = 0.76). Most would be happy for future screening at 6-weeks postnatal, 97/102 (95%) and 85/95 (89%) when asked at 6- and 12-week study visits, respectively. Agreement rate of clinician-taken HPV tests between 6- and 12-weeks was 94.8% (91/96, 95% confidence interval [CI], 88.4%-97.8%), with no inadequate combination HPV/cytology tests (6 vs. 12-week: sensitivity 80% [95% CI, 44.4-97.5]; specificity 96.5% [95% CI 90.1-99.3]). Relative to 12-week clinician-taken samples, urine self-sampling may have lower sensitivity for HPV (e.g., 6-week: sensitivity 60.0% [95% CI 26.2-87.8]; specificity 96.5% [95% CI 90.1-99.3]; NPV 95.4% [95% CI 88.6-98.7]).

Conclusions: A paired-sample study of cervical screening at 6- and 12-weeks is feasible. Inadequacy rates of cervical screening were low, with high agreement. Urine self-sampling may be less sensitive in this population.

Keywords: cervical screening; postnatal; self‐sampling.