Many people now have a new option for cervical cancer screening: self-collection of vaginal samples for HPV testing. This less invasive method allows individuals to collect their own samples, either at a healthcare provider’s office or, increasingly, at home, offering a potentially more private and accessible way to stay on top of their health.
The U.S. Health Resources and Services Administration (HRSA) recently indicated that self-testing is an option for many, moving away from the traditional requirement of a pelvic exam performed by a clinician. This shift reflects a growing emphasis on patient convenience and expanding access to crucial preventative care.
While at-home HPV testing represents a significant step forward, it’s not a replacement for comprehensive gynecological care. As Jeanne Conry, an ob-gyn and former chair of the Women’s Preventive Services Initiative, points out, “If we see ourselves only as the Pap smear specialists, we have failed [patients].” A regular visit to an ob-gyn encompasses a broader range of health assessments and consultations.
Cervical cancer screening is undeniably vital. Data consistently shows that a substantial proportion of those diagnosed with the disease are either unscreened or under-screened. Approximately 25% of U.S. Women were not up-to-date with screenings as of , according to the American Cancer Society. Self-collection tests have the potential to improve screening rates, particularly among those who face barriers to traditional methods.
It’s important to understand that a positive result from an at-home test typically necessitates a follow-up examination with a healthcare provider. Individuals at higher risk for cervical cancer – those with compromised immune systems or a history of precancerous conditions – should continue to receive regular screenings from a doctor. Similarly, women in their , when HPV infections are common, should prioritize regular screenings, even if those infections are usually harmless, explains Amanda Bruegl, a gynecologic oncologist at the Oregon Health and Science University School of Medicine.
While some research suggests self-collected samples are comparable in accuracy to those collected by clinicians, the American Cancer Society still recommends clinician-led HPV testing when possible. This preference stems from the holistic care provided during a traditional gynecological visit.
The average well-woman visit extends far beyond a Pap smear – which, even before the HRSA’s recent guidance, didn’t require annual testing for most patients. These appointments often include breast exams, discussions about contraception and family planning, screening for sexually transmitted infections, and conversations about menstrual health or menopause, according to Colleen Denny, an ob-gyn based in New York and a fellow of the American College of Obstetricians and Gynecologists.
“We have to talk about all the things that have happened to you in your reproductive life all year,” Denny says. “It’s great that we don’t have to wedge a Pap smear into there also.”
In the United States, where nearly a third of the population experiences limited access to primary care, an ob-gyn often serves as the primary healthcare provider for many individuals. A study revealed that, between and , reproductive-age women were more likely to have preventative health visits with ob-gyns than with generalist physicians.
The role of ob-gyns often extends beyond reproductive health. Denny notes that she frequently addresses issues like refilling asthma inhalers and screening for depression. Bruegl adds that blood pressure checks, vaccinations, and general health maintenance are also commonly addressed during these visits.
Skipping regular appointments means missing out on essential care. While HPV testing can now be done at home, “someone should be talking about all the [other] basic health screenings, all the basic wellness things, every single year,” Bruegl emphasizes.
The Food and Drug Administration (FDA) initially approved HPV tests allowing for self-collection in healthcare settings on . These tests, including Onclarity HPV (Becton, Dickinson and Company) and cobas HPV (Roche Molecular Systems), offer an alternative for those who cannot or prefer not to undergo a pelvic exam. The NCI-led “Last Mile” Initiative aims to accelerate the development and approval of even more accessible self-collection methods, including at-home options.
The introduction of the first FDA-approved at-home self-collection cervical cancer screening kit, the Teal Wand, in , further expands access to screening. This new guidance builds on recommendations issued by the U.S. Preventive Services Task Force (USPSTF) in , which advocated for self-collected HPV testing as a viable option for cervical cancer screening, particularly for individuals facing barriers to traditional in-office care.
