Our Review Summary
This release focuses on recent "proof-in-principle" research that found that it is feasible to use home testing devices to screen low-income women with limited access to medical care for infection with human papillomavirus (HPV), which can cause cancer cervix . Disengagement can do more to clarify the sensitivity and specificity of the screening tool, but do a good job of explaining that more work must be done before this approach can be applied on a broad scale.
Why is this important?
As noted by the National Cancer Institute, almost all cervical cancers are caused by HPV – with most being caused by certain types of HPV. And early diagnosis of HPV infection can help prevent cancer, or allow patients and health care providers to warn them they need to monitor cervical cancer. It makes screening for HPV important, and especially for patients with limited resources who may not have regular access to health care providers for routine checks or examinations. And risky communities are precisely what this research wants to overcome. It is important to clarify – like this release – the costs remain a challenge, and that regulatory barriers remain. Most importantly, the release emphasizes that more work needs to be done before this approach to screening moves from theoretical to practical.
Does the news release adequately address the cost of intervention?
This release does not place pricetag on HPV screening – which will include test kits, analysis and follow-up clinical visits. However, the release explicitly stated that "there is a lot of work to be done, such as identifying ways to make the self-gathering process more efficient and cost-effective." Recognition is enough to get a satisfactory assessment here.
Does the news release adequately measure the benefits of treatments / tests / products / procedures?
This is a complicated question, because it is not clear how people should define the relevant benefits. The paper itself defines the purpose of this study as evaluating "validity and acceptance" of the collection at home sample for HPV screening. If part of the "acceptance" assessment determines whether sending a self-collection kit improves screening, is the benefit determined as successfully sending a sample for screening? If so, the release failed, because it did not tell the reader how many women received the mail screening test (284 women, according to the related paper). However, validity is easier to handle. How well are the samples taken at home compared to other screening tests? This release discusses this. This stated that home testing, which was collected alone showed 12.4% of women had high-risk HPV infection. In the clinic, the tests collected alone showed 15.5% had high risk HPV infection. And tests collected by doctors showed 11.4% of women had high-risk HPV infection. That is a difficult number, and we will provide the release of the benefits of this one doubt. However, the three different numbers raise a number of questions, which the release did not resolve. More about that below.
Does the news release adequately explain / measure the danger of intervention?
This release does not address two main potential hazards, namely the failure to identify someone who has a high-risk HPV, and "wrong positive" misdiagnosis of people who do not have high risk HPV. This is the difference between "sensitivity" and "specificity." This is very relevant in this regard because HPV screening has a track record of problems with specificity and sensitivity – and because the release itself makes it clear that there are people diagnosed with high risk. in some screening tests, but not others. Missing a high-risk person is clearly problematic. But being told that a person faces significant medical risks that a person does not really face can also have consequences for future health care, with both physical and financial consequences.
Another possible damage is the level of certain patients sending the test but not following up, leaving the doctor with a positive test and missing patients to follow up which will reduce the impact of the examination effort.
Does the news release seem to understand the quality of the evidence?
This comes down to a very simple problem: the release gives the reader key information and then fails to explain it. This concern is related to the lack of a comparison in the results of screening in three types of tests: home tests, which were collected alone showed 12.4% of women had high-risk HPV infection; in the clinic, the tests collected alone showed 15.5% had high risk HPV infection; and tests collected by doctors showed 11.4% of women had high-risk HPV infection.
For most readers, the difference between 11.4% and 15.5% looks like a lot – more than 4%. If they do math at home, they will see that eight people (from 193) are diagnosed with high risk in one scenario, but not in another scenario. What gives? But this release only addresses this with a quote that says "We find comparable detection between self collections and doctor collections." That doesn't help. In addition, this release refers more than once to the fact that "all women who were found to have high-grade cervical lesions … were positive for high-risk HPV in the samples they collected themselves." But the release did not tell them that this group consisted of less than 10 people, or to what extent can be extrapolated to a larger population. In short, it is important to discuss sensitivity and specificity when writing about diagnostic tools.
Does the news release carry out disease dissemination?
HPV – specifically certain HPV types – can significantly increase the risk of cervical cancer. There is no doubt about that. However, not all women who contract HPV will get cervical cancer. There is no doubt about that either. In fact, the CDC notes that 80 percent of women have HPV when they are 50 years old, but the National Cancer Institute estimates that less than one percent of women will get cervical cancer in their lifetime. It is difficult to highlight the importance of screening HPV without crawling into the area of "disease blockage". This release goes to the line, but does not cross it.