@article {Landye538, author = {Rebecca Landy and Tony Hollingworth and Jo Waller and Laura AV Marlow and Jane Rigney and Thomas Round and Peter D Sasieni and Anita WW Lim}, title = {Non-speculum clinician-taken samples for human papillomavirus testing: a cross-sectional study in older women}, volume = {72}, number = {721}, pages = {e538--e545}, year = {2022}, doi = {10.3399/BJGP.2021.0708}, publisher = {Royal College of General Practitioners}, abstract = {Background Cervical cancer incidence and mortality are high in women aged >=65 years, despite the disease being preventable by screening. Speculum-based screening can become more uncomfortable after the menopause.Aim To examine test performance and acceptability of human papillomavirus (HPV) testing on clinician-collected vaginal samples without a speculum (non-speculum).Design and setting Cross-sectional study in 11 GP practices and four colposcopy clinics in London, UK, between August 2017 and January 2019.Method Non-speculum and conventional (speculum) samples were collected from women aged >=50 years attending for a colposcopy (following a speculum HPV-positive screening result) or women aged >=35 years (with confirmed cervical intraepithelial neoplasia (CIN) 2+), and women aged 50{\textendash}64 years attending routine screening. Sensitivity to CIN2+ was assessed among women with confirmed CIN2+ (colposcopy). Specificity to HPV relative to speculum sampling and overall concordance was assessed among women with negative cytology (routine screening).Results The sensitivity of non-speculum sampling for detecting CIN2+ was 83.3\% (95\% confidence interval [CI] = 60.8 to 94.2) (n = 15/18). There was complete concordance among women with positive CIN2+ who had a speculum sample <=91 days prior to the non-speculum sample (n = 12). Among 204 women with negative cytology, the specificity to HPV was 96.4\% (95\% CI = 92.7 to 98.5), with 96.6\% concordant results (κ 72.4\%). Seventy-one percent (n = 120/170) of women preferred a non-speculum sample for their next screen.Conclusion HPV testing on non-speculum clinician-taken samples is a viable approach that warrants further exploration in larger studies. Overall test performance was broadly comparable with that of self-sampling.}, issn = {0960-1643}, URL = {https://bjgp.org/content/72/721/e538}, eprint = {https://bjgp.org/content/72/721/e538.full.pdf}, journal = {British Journal of General Practice} }