Home-Based or Clinic-Based Human Papillomavirus (HPV) Screening

NCT ID: NCT01550783

Last Updated: 2020-07-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1335 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-03-31

Study Completion Date

2017-11-16

Brief Summary

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This randomized clinical trial studies home-based HPV or clinic-based Pap screening for cervical cancer. It is not yet known whether home-based screening is more effective, cost-effective, and/or acceptable than clinic-based screening for cervical cancer.

Detailed Description

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PRIMARY OBJECTIVES:

I. Compare the sensitivity and specificity for cervical intraepithelial neoplasia (CIN) of two screening approaches:

* Novel approach: every 3 years high risk-human papillomavirus (HR-HPV) testing of (at home) self-collected samples with in-clinic cytology of HR-HPV positive women and referral to colposcopy of women with cytology \> atypical squamous cells of uncertain significance (ASCUS); repeat HPV testing of HR-HPV positive but cytology negative women at one year;
* Currently recommended approach: for women \< 30: every 3 years in-clinic cytology screening, with HPV based triage of women with ASCUS and referral to colposcopy of all women with squamous intraepithelial lesion (SIL) and/or HPV+ ASCUS; for women 30+, screening by Papanicolaou (Pap) and HPV, every 2-3 year (depending on previous history) with referral to colposcopy of those who are HPV 16/18+ or with cytology \> ASCUS; retesting of those who are positive for other HR-HPV at one year.

II. Compare these two approaches with respect to overall cost-effectiveness and acceptability.

III. Determine the performance and cost-effectiveness of each approach in vaccinated and unvaccinated women \< 30.

OUTLINE: Participants are randomized to 1 of 2 arms.

GROUP I (home-based HPV screening): Participants collect 2 vaginal specimens using polyester swabs. Participants with a positive HPV test result will have a Pap test. Participants with an abnormal Pap test will undergo standard of care as in Group II.

GROUP II (clinic-based standard of care screening): Participants undergo Pap testing. Participants with a positive Pap test undergo standard of care, including colposcopy, HPV testing, cervical biopsy and/or endocervical curettage (ECC). Participants with cervical biopsies showing precancerous changes requiring treatment may undergo loop electrosurgical excision procedure (LEEP) or are referred to appropriate care.

Conditions

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Atypical Squamous Cell of Undetermined Significance Cervical Carcinoma Cervical Intraepithelial Neoplasia Grade 2/3 Health Status Unknown Human Papillomavirus Infection Low Grade Cervical Squamous Intraepithelial Neoplasia Stage 0 Cervical Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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Group I (home-based HPV screening)

Participants collect 2 vaginal specimens using polyester swabs that are then placed in a specimen tube. Specimens are then submitted to the Harborview Medical Center clinical pathology lab. Participants with a positive HPV test result will have a Pap test. Participants with an abnormal Pap test will undergo standard of care as in Group II.

Group Type EXPERIMENTAL

Cytology Specimen Collection Procedure

Intervention Type OTHER

Undergo home-based HPV screening

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Screening Method

Intervention Type PROCEDURE

Undergo home-based HPV screening

Group II (clinic-based standard of care screening)

Participants undergo standard of care cervical cancer screening and follow-up. That is, participants undergo Pap testing. Participants with an abnormal Pap test undergo HPV testing, colposcopy, cervical biopsy and/or ECC. Participants with cervical biopsies showing precancerous changes are offered to undergo LEEP or are referred to appropriate care.

Group Type EXPERIMENTAL

Cervical Papanicolaou Test

Intervention Type OTHER

Undergo standard of care Pap test screening

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Screening Method

Intervention Type PROCEDURE

Undergo standard of care Pap test screening

Interventions

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Cervical Papanicolaou Test

Undergo standard of care Pap test screening

Intervention Type OTHER

Cytology Specimen Collection Procedure

Undergo home-based HPV screening

Intervention Type OTHER

Questionnaire Administration

Ancillary studies

Intervention Type OTHER

Screening Method

Undergo standard of care Pap test screening

Intervention Type PROCEDURE

Screening Method

Undergo home-based HPV screening

Intervention Type PROCEDURE

Other Intervention Names

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Cervical Pap Test Cytologic Sampling

Eligibility Criteria

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Inclusion Criteria

* Able to provide informed consent in English

Exclusion Criteria

* Have had hysterectomy
* Currently pregnant
* Received treatment of cervical dysplasia with LEEP, cone biopsy, laser procedure or cryotherapy within THREE years
* Received colposcopy of cervix within TWO years
* Received Pap test within ONE year
* Immunocompromised (positive human immunodeficiency virus \[HIV\] test, transplant recipient, received chemotherapy for cancer, or taking immunosuppressant drugs)
* Decisionally impaired adults requiring a legally authorized representative
Minimum Eligible Age

21 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nancy Kiviat

Role: PRINCIPAL_INVESTIGATOR

Fred Hutch/University of Washington Cancer Consortium

Locations

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University of Minnesota/Masonic Cancer Center

Minneapolis, Minnesota, United States

Site Status

Fred Hutch/University of Washington Cancer Consortium

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Feder MA, Kulasingam SL, Kiviat NB, Mao C, Nelson EJ, Winer RL, Whitham HK, Lin J, Hawes SE. Correlates of Human Papillomavirus Vaccination and Association with HPV-16 and HPV-18 DNA Detection in Young Women. J Womens Health (Larchmt). 2019 Oct;28(10):1428-1435. doi: 10.1089/jwh.2018.7340. Epub 2019 Jul 2.

Reference Type DERIVED
PMID: 31264912 (View on PubMed)

Mao C, Kulasingam SL, Whitham HK, Hawes SE, Lin J, Kiviat NB. Clinician and Patient Acceptability of Self-Collected Human Papillomavirus Testing for Cervical Cancer Screening. J Womens Health (Larchmt). 2017 Jun;26(6):609-615. doi: 10.1089/jwh.2016.5965. Epub 2017 Mar 23.

Reference Type DERIVED
PMID: 28332888 (View on PubMed)

Other Identifiers

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NCI-2013-00745

Identifier Type: REGISTRY

Identifier Source: secondary_id

7489

Identifier Type: OTHER

Identifier Source: secondary_id

R01CA157469

Identifier Type: NIH

Identifier Source: secondary_id

View Link

7489

Identifier Type: -

Identifier Source: org_study_id

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