EXECUTIVE SUMMARY

Self-sampling HPV testing kits may help more women get screened for cervical cancer. Results from a new study of 20,000 women indicate that home testing may be a viable option for increasing screening rates.

Women who received a kit mailed to their home were 50% more likely to be screened compared to those who received usual care.

Women in the mail group were screened more quickly.

Other countries, such as Australia and the Netherlands, include the option of home HPV screening for underscreened women.


In the United States, more than 50% of cervical cancers are diagnosed in underscreened women.1 In 2016 (the latest year for which incidence data are available), almost 13,000 new cases of cervical cancer were reported in the United States, and 4,188 women died of the disease.2

Mailed self-sampling kits that test for human papillomavirus (HPV) may increase the number of women screened for cervical cancer. Results from a new study of 20,000 women, conducted by researchers from the University of Washington and Kaiser Permanente Washington Health Research Institute, indicate that home testing may be a viable option for increasing screening rates.3

Researchers followed female members of Kaiser Permanente Washington who were 30-64 years of age and overdue for cervical cancer screening. Researchers randomly assigned the women to receive either usual care, which consisted of annual patient reminders and outreach from primary care clinics, or usual care plus a mailed HPV test kit, with instructions for collecting a sample at home. Women in the second group could either choose to complete the self-collection kit and return samples in the mail, or go to a clinic for screening. Primary outcomes were cervical intraepithelial neoplasia grade 2 or worse (CIN2+) detection within six months of screening and treatment within six months of detection. Screening uptake within six months of randomization was a secondary outcome set by researchers.

According to Diana Buist, PhD, senior investigator and director of research and strategic partnerships at Kaiser Permanente Washington Health Research Institute, women who received a kit were 50% more likely to be screened compared to those who received usual care. Women in the mailing group were screened faster, Buist said in a statement.4

Many women may be overdue for cervical cancer screening because they dislike the procedure, or simply do not have the time for in-clinic screening, said Buist. “HPV testing in the privacy and comfort of home promises to put care in the hands of women, remove barriers to care, and increase access and affordability,” she stated.

Studies have shown that an HPV test on a self-collected sample performs as well as a physician-collected sample,5 noted lead author Rachel Winer, PhD, MPH, professor of epidemiology at the University of Washington School of Public Health and an affiliate investigator at Kaiser Permanente Washington Health Research Institute.

“Randomized trials in other countries have shown that offering home-based HPV testing increases screening participation, but this was the first U.S. trial to study the impact of mailed kits in a real-world health system setting,” Winer said.6

Other countries, such as Australia and the Netherlands, include the option of home HPV screening for underscreened women, noted Winer. Winer and Buist are spearheading a follow-on trial that also will include women who are up to date with cervical cancer screening. With further research in hand, the scientists hope that home HPV screening can become a useful option for all eligible patients, similar to Kaiser Permanente Washington’s practice of mailing stool test kits for colorectal cancer screening.

Meta-Analysis Shows Support

Results from a recent meta-analysis indicate that women who had the option of collecting their own sample for HPV testing were twice as likely to seek cervical cancer screening as those who relied on standard screening practices.7 The study was conducted by researchers in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, the World Health Organization (WHO), and the International Agency for Research on Cancer. WHO used information from the meta-analysis to develop new recommendations for key self-care interventions for sexual and reproductive health and rights in light of vulnerable populations and settings with health systems that have limited capacity and resources.

“Self-care is an integral component of the health system,” Caitlin Kennedy, PhD, MPH, an author of the study and an associate professor of international health at the Bloomberg School of Public Health, said in a statement. “With the right approach, evidence-based self-care interventions for sexual and reproductive health can empower individuals and help achieve universal health coverage by making critical interventions more widely available around the world.”8

According to the latest U.S. Preventive Services Task Force cervical cancer screening recommendations, all women ages 21-29 years should be tested every three years with cervical cytology. For women ages 30-65 years, recommendations call for screening with the Pap test alone every three years, screening with the high-risk HPV test alone every five years, or screening with both tests together every five years.9

Recent CDC data indicate that an estimated 92% of cancers caused by HPV could be prevented by vaccine.10 The federal agency will continue to push for increasing HPV vaccination coverage to 80%, which is set as the Healthy People 2020 target.

REFERENCES

  1. National Institutes of Health. Cervical cancer: NIH Consensus Development Conference Statement. 1996;14:1-38.
  2. American Cancer Society. Key statistics for cervical cancer. Available at: http://bit.ly/2kUcifg.
  3. Winer RL, Lin J, Tiro JA, et al. Effect of mailed human papillomavirus test kits vs usual care reminders on cervical cancer screening uptake, precancer detection, and treatment: A randomized clinical trial. JAMA Netw Open 2019;2:e1914729.
  4. Kaiser Permanente Washington Health Research Institute. Mailing home HPV tests may provide alternative to Pap screening. Nov. 6, 2019. Available at: https://bit.ly/2qdUssX.
  5. Gupta S, Palmer C, Bik EM, et al. Self-sampling for human papillomavirus testing: Increased cervical cancer screening participation and incorporation in international screening programs. Front Public Health 2018;6:77.
  6. Ellison J; University of Washington. Mailed self-sampling kits helped more women get screened for cervical cancer. Nov. 6, 2019. Available at: https://bit.ly/2q0EyCg.
  7. Yeh PT, Kennedy CE, de Vuyst H, et al. Self-sampling for human papillomavirus (HPV) testing: A systematic review and meta-analysis. BMJ Global Health 2019;4:e001351.
  8. Johns Hopkins University Bloomberg School of Public Health. Women who have option of using HPV self-sampling kits more likely to seek cervical cancer screening, new analysis finds. Aug. 15, 2019. Available at: https://bit.ly/2CIr0xW.
  9. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA 2018;320:674-686.
  10. Senkomago V, Henley SJ, Thomas CC, et al. Human papillomavirus-attributable cancers — United States, 2012-2016. MMWR Morb Mortal Wkly Rep 2019;68:724-728.