Article Text

Feasibility of self-sampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest Ontario, Canada: a pilot study
  1. Ingeborg Zehbe1,
  2. Helle Moeller1,
  3. Alberto Severini2,
  4. Bruce Weaver3,
  5. Nicholas Escott4,
  6. Crystal Bell5,
  7. Sandra Crawford5,
  8. Diane Bannon5,
  9. Natalie Paavola5
  1. 1Thunder Bay Regional Research Institute, Thunder Bay, Ontario, Canada
  2. 2National Microbiology Laboratory, Health Canada, Winnipeg, Manitoba, Canada
  3. 3Northern School of Medicine, West Campus, Thunder Bay, Ontario, Canada
  4. 4Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
  5. 5Dilico Family Health Team, Thunder Bay, Ontario, Canada
  1. Correspondence to Dr Ingeborg Zehbe; zehbei{at}


Background The incidence of cervical cancer is up to sixfold higher among First Nation women in Canada than in the general population. This is probably due to lower participation rates in cervical cancer prevention programmes.

Objective To raise screening participation in this underserved population by launching an alternative approach to (Pap)anicolaou testing in a clinic—namely, vaginal self-sampling followed by human papillomavirus (HPV) diagnostics.

Methods Good relationships were established with a First Nation community of the Northern Superior region in Northwest Ontario, and then 49 community women, aged 25–59, were recruited, who provided a vaginal self-sample and answered a questionnaire. Frequency distributions and cross-tabulations were used to summarise the data. Associations between categorical variables were assessed using the χ2 test of association, or the Goodman–Kruskal γ if both variables had ordered categories. Self-collected samples were tested for integrity and HPV using optimised molecular biological methods.

Results The majority of participants (87.2%) were amenable to future HPV screening by self-sampling. This finding was independent of age, educational level and a previous history of abnormal Pap tests. Interestingly, the preferred way to learn about sexual health remained through interaction with healthcare professionals. As defined by the presence of a housekeeping gene, self-sample integrity was high (96%). Using polymerase chain reaction-based Luminex typing, the overall HPV positivity was 28.6% (ie, with either a low- or high-risk type) and 16.3% were infected with a high-risk type such as HPV16.

Conclusion In this pilot study of First Nation women, self-sampling and HPV testing was well received and self-sample quality was excellent. A larger survey to be conducted in other Northern Superior communities in Northwest Ontario will determine whether this approach could become a viable screening strategy for First Nation women.

  • Cervical cancer screening
  • Pap test
  • HPV test
  • self-sampling
  • First Nation women
  • virology
  • oncology
  • gynaecological oncology

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Zehbe I, Moeller H, Severini A, et al. Feasibility of self-sampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest Ontario, Canada: a pilot study. BMJ Open 2011;1:e000030. doi:10.1136/bmjopen-2010-000030

  • Funding The Northern Health Fund provided financial support for this pilot project.

  • Competing interests There are no industry relationship with the present study.

  • Patient consent The research nurse provided information orally and through the informed consent form, which was explained to, and signed by, the volunteer before taking a self-sample.

  • Ethics approval Ethics approval was provided by Thunder Bay Regional Health Sciences Centre.

  • Contributors IZ designed and conducted most of the study and took the lead in performing the statistical analyses together with BW and in writing the manuscript. HM assisted substantially in these activities and NE assisted with study design and writing up the manuscript. AS performed HPV testing and typing. CB, SC, DB and NP provided input to the study design and instructed volunteers about sample taking and filling out the questionnaire. All authors provided input into writing the manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Technical appendix, statistical code, and dataset available from the corresponding author at zehbei{at} Consent was not obtained but the presented data are anonymised and risk of identification is low also because questionnaires were coded and researchers had no access to the names of the participants.

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