Self-Testing and the Global Goal of Eliminating Cervical Cancer

You might have heard of human papillomavirus (HPV), a sexually transmitted infection that can lead to cervical cancer.

You might not know that HPV is the most common sexually transmitted infection, nor that the HPV vaccine is highly effective at preventing cancer.

Cervical cancer screening, specifically, remains an important prevention and detection tool that is recommended for all women.

But we need more than the vaccine to protect girls and women from this preventable infectious disease and the cancer it can cause. Because—while a vaccine for HPV exists—the World Health Organization (WHO) has a long way to go to achieve their goal of 90% vaccination worldwide by 2030 in all girls prior to turning 15.

As with all vaccines, barriers to distribution exist—such as vaccine storage and access to injections. Barriers to uptake include hesitancy due to real and perceived risks. And, as with all vaccines, the HPV vaccine is effective against only half of the types of HPV that cause cervical cancer. Undoubtedly, women will need a booster for continued protection.

Diane M. Harper, professor of Family Medicine and Obstetrics and Gynecology, recently outlined the road to cervical cancer elimination, and the path is about more than vaccines.

Cervical cancer screening, specifically, remains an important prevention and detection tool that is recommended for all women at varying intervals throughout the course of life.

As with vaccination, barriers to screening exist, the most obvious being the speculum-based approach used for most cervical cancer screening.

This method deters many women because it is invasive. In a clinical setting, the vagina is opened with a speculum and the cervix is then swabbed to collect a sample of cells for testing. In the past, tests were run both for the presence of HPV—the cause of cervical cancer—and for cervical cytology, a test examining a single cell type to reflect whether cancerous changes are starting. Now HPV testing happens first. If an infection is detected, cytology then helps determine whether the woman needs immediate treatment or if it is safe to watch while the infection goes away.

Can the current speculum-based approach be improved?

Healthcare providers are increasingly recommending self-swab testing, a process by which the woman collects the sample herself. Growing data suggest that self-swab tests—which process the sample using DNA from HPV rather than looking at cell shape with cytology—produce more accurate results and find existing cancer markers. HPV detection in this way does not require repeated tests over time to find precancers—while the cytology test does.

The self-swab method eliminates the need for an invasive speculum procedure conducted by a provider. The woman screens herself in private with a device she uses herself.

Regardless of the screening test used, a significant number of women with abnormal test results do not return for continued work-up. Sometimes follow up is not needed for one year, creating a significant time lag that contributes to the gap in follow up.

As self-swabbing becomes a strong alternative to more invasive methods of cervical cancer screening, the self-swabbing can provide a comfortable and easy way for follow up to occur. The lack of follow up among women who require an invasive speculum-based exam must still be addressed. But researchers hope the ability to self-test will lead to more screening in general and an alternative follow-up for some abnormal test results.