By Rebecca Bowers

There is a continued need to improve prevention of cervical cancer. In 2018, estimates indicated that 13,240 women in the United States would develop invasive cervical cancer, with about 4,170 dying of the disease.1 Although screening for human papillomavirus (HPV) may detect cervical cancer early, many women may forego such tests.

Statistics suggest that more than half of U.S. invasive cervical cancer cases occur in women who are underscreened (defined as infrequently or never screened).2 About 15% of women report not receiving Pap testing in the preceding three years, making them overdue for Pap testing according to national recommendations.3

Why are women missing needed screening? Barriers include lack of health insurance, poor access to medical services, and embarrassment or discomfort with pelvic examin-ation.4,5 Now, researchers are looking at the effectiveness of using at-home collection kits for women who are overdue for screening to overcome some of these barriers.6,7

Many different barriers are causing women to be underscreened, notes researcher Andrea Des Marais, MPH, project manager at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health. Although HPV tests are used in the United States, they are currently available for collection only by physicians in clinical practice, which requires women to visit a clinic, she states.

“Offering HPV testing using self-collection by mail has a lot of potential to reach women who are the highest risk of being under-screened: those who don’t access regular medical care,” said Des Marais in a press statement.

Take a Closer Look

Des Marais and fellow researchers looked at the potential of self-collection in a just-published study.6 To perform the investigation, the researchers sent home kits by mail for self-collection to low-income North Carolina women who were overdue to receive screening. Participants included women between ages 30-64 who had reported no history of receiving a Pap test within the past four years.

The women received self-collection brushes as well as instructions for taking samples. A lab then tested the samples for HPV and other sexually transmitted infections. Participants also collected the samples themselves at a clinic, and received a pelvic exam for a Pap smear sample. The researchers then compared the results from self-collected samples and the ones collected by clinicians to the results of the Pap smears and cervical biopsies obtained during colposcopy.

According to the research findings, the home self-collection tests found 12.4% of women to be infected with high-risk HPV. The self-collection tests in the clinic found 15.5% of women infected with high-risk HPV, and the tests collected by clinicians found 11.4% of the women had high-risk HPV infection.6 The women found to have high-grade cervical lesions through a Pap smear or cervical biopsy all tested positive for high-risk HPV with the samples collected at home, researchers note.

“Women are dying unnecessarily of cervical cancer because they either haven’t been vaccinated against HPV in adolescence, or they have not been getting screened according to national guidelines,” says researcher Jennifer Smith, PhD, professor in the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health. “Increasing screening rates among underscreened women is of paramount importance.”

Will Women Use the Test?

Researchers at The Ohio State University also have published findings that mailing at-home HPV tests may be effective for reaching women who may have limited access to healthcare.7 In their study, investigators found that almost 80% of women who received the kits used them and sent them back to the researchers for testing. About 25% of the tests were positive for a cancer-causing type of HPV.

To conduct the study, investigators contacted participants first to gauge their interest. Then researchers sent screening kits for return by U.S. mail. Women received up to $85 in gift cards for their participation, although no cards were issued for returning the screening kit. About half of the 103 women in the study had not been screened for cervical cancer through Pap testing in more than five years.

Although at-home HPV tests are used widely in other countries, including Australia and the Netherlands, they are not yet an approved or recommended screening approach in the United States. That may change as more research emerges on their safety, efficacy, and acceptability.

“There’s a lot of interest in exploring more widespread use of these tests in the U.S., particularly to increase screening rates among women who aren’t getting regular care,” says Paul Reiter, PhD, MPH, the study’s lead author, and associate professor of health behavior and health promotion at The Ohio State University. Reiter also serves as a member of the Cancer Control research program at Ohio State’s Comprehensive Cancer Center.

REFERENCES

  1. American Cancer Society. Key statistics for cervical cancer. Available at: http://bit.ly/2kUcifg. Accessed Dec. 19, 2018.
  2. Spence AR, Goggin P, Franco EL. Process of care failures in invasive cervical cancer: Systematic review and meta-analysis. Prev Med 2007;45:93-106.
  3. Solomon D, Breen N, McNeel T. Cervical cancer screening rates in the United States and the potential impact of implementation of screening guidelines. CA Cancer J Clin 2007;57:105-111.
  4. Centers for Disease Control and Prevention (CDC). Cancer screening — United States, 2010. MMWR Morb Mortal Wkly Rep 2012;61:41-45.
  5. Bukowska-Durawa A, Luszczynska A. Cervical cancer screening and psychosocial barriers perceived by patients: A systematic review. Contemp Oncol (Pozn) 2014;18:153-159.
  6. Reiter PL, Shoben AB, McDonough D, et al. Results of a pilot study of a mail-based HPV self-testing program for underscreened women from Appalachian Ohio. Sex Transm Dis 2018; doi: 10.1097/OLQ.0000000000000944. [Epub ahead of print].
  7. Des Marais AC, Zhao Y, Hobbs MM, et al. Home self-collection by mail to test for human papillomavirus and sexually transmitted infections. Obstet Gynecol 2018;132:1412-1420.