Making the case for self-collection HPV screening in the US

The journal Obstetrics & Gynecology recently published the results of mailing self-collection HPV kits to low-income women in North Carolina. The results, confirmed by subsequent identification of abnormal cervical precancerous growths, were that all high-risk HPV cases were detected through the self-collection kits.

"This is a demonstration that mailing self-collection kits and returning them to test for high-risk HPV infection has big potential to increase screening access among under-screened women, and to do that successfully," said UNC Lineberger's Jennifer S. Smith, the study's senior author, and a professor in the UNC Gillings School of Global Public Health.

Currently, the FDA has signed off on the use of HPV tests as a screening method for cervical cancer in women over 25 years, in conjunction with a Pap test. The US Preventive Services Task Force gave an ‘A rating’ to HPV screening alone for women between 30 and 65 years. However, to date, the FDA has not approved self-collection of samples for HPV testing.

  • Research has shown a 30% improvement in detection of high grade lesions with HPV testing, compared to the Pap smear (cytology).
  • A negative HPV test gives greater reassurance against the development of cervical cancer in the three years following the test.
  • The Netherlands and Australia are two countries that have transitioned to primary HPV screening as part of their national cervical cancer prevention programs.
  • Self-collected samples show comparable sensitivity to clinician-collected samples.
  • Self-collection has proved highly favourable to women.
  • Some of the factors associated with under-screening – time, cost, discomfort, lack of resources – may be solved through self-collection.
  • One systematic review showed that invitation to self-collect HPV samples rather than attend a clinic doubled participation in screening among women.

Given that a visit to the clinic for a Pap smear is often an entry point for women to access multiple other services, self-collected HPV testing should not replace current screening practices entirely. However, it can serve as a good compliment to current programs, allowing rural and other hard-to-reach women a chance to be screened.