Genital human papillomavirus (HPV) is the most common STI in the U.S. and is the biggest risk factor for developing cervical cancer, now accounting for 90% of anal and cervical cancer, according to the Centers for Disease Control and Prevention.
Though its deadly effects can be prevented through early detection, barriers to testing prevent some women from screening to catch HPV before it develops into cancer. A new study by the National Cancer Institute (NCI) is looking to explore how effective self-tests are, which could prove to be monumental for women between the ages of 35 and 44, who are most frequently diagnosed, according to the American Cancer Society.
The Cervical Cancer ‘Last Mile’ Initiative is a public-private partnership between NCI and 24 sites around the country, including the University of Cincinnati Cancer Center (UC), who will conduct trials allowing patients to self-collect vaginal samples for HPV testing in hopes of improving cervical cancer prevention and proving that at home collections are as effective and accurate of those done at clinics.
Dr. Leeya Pinder is an associate professor in the UC College of Medicine Department of Obstetrics and Gynecology and the local principal investigator of the trial. She says that this method is simple enough for patients to do at home and remain effective.
“It really gives people the opportunity to just do a vaginal swab or a cervico-vaginal swab so that they can get tested for high-risk HPV, which is usually the driver of cervical precancer and cervical cancer,” she said. “What we’ve been trying to do over the last several years is prove that women can actually do HPV testing on their own.”
Though self-collection HPV testing is not currently approved by the U.S. Food and Drug Administration, similar programs have already been piloted in Latin American and European countries. In Sweden, to ensure testing was still done during the COVID-19 pandemic shutdown in 2020, HPV self-testing kits were sent to women in the country between the ages of 23 and 29, who had previously been offered screening through pap smears. According to the World Health Organization (WHO), 330,000 self-sampling kits were sent out in Stockholm alone, resulting in a 10% increase in testing in one year.
“With the new measures against human papillomavirus (HPV), we predict that cervical cancer elimination in Sweden could happen 5 years from now. If the pandemic had not occurred, it would have been much, much slower,” Professor Joakim Dillner, a cancer specialist at the Karolinska Institutet in Sweden told WHO.
He explained that self-testing could cut global healthcare services time and costs tied to bringing providers into clinics to conduct tests.
“The self-sampling kit is not highly specialized. It’s basically the same thing as a mascara brush that a woman might use for her eyelashes,” said Dillner. “These are very simple, low-cost sampling kits that are part of the HPV screening test.”
Vaccinations, screening encouraged but not everyone can access care
HPV vaccines have proven to be effective in the U.S., reducing cervical cancer rates in women between 20 to 24 by 11% annually from 2012 to 2019. However, vaccinations are usually only offered to pre-teens and teenagers, and not recommended past 26, as most adults by this age have already been exposed to HPV.
With over half of cervical cancer cases occurring in patients who had never been screened or were not regularly screened, intervention through HPV testing is essential to decreasing the deadly effects. The American Cancer Society estimates that 4,360 women in the U.S. will die from cervical cancer in 2024, with Black and Latina women most at risk.
While Latinas have the highest rates of getting cervical cancer, Black women have the highest mortality rates of the disease, a paradox pointed out by a 2021 KFF report, which noted that Black women also have the highest rates of pap smear testing. About 79% of Black women reported having a pap smear in the past two years, compared to 68% of white women, 66% of Latinas and 65% of Asian women.
Insurance is a major barrier to receiving preventative care, including pap tests. Women with low-incomes, BIPOC and undocumented women are more likely to be uninsured. According to KFF, 20% of Hispanic and American Indian and Alaska Native women are insured in 2022.
Pinder said that self-testing could make preventative care accessible to those facing the most barriers.
“Those populations include those who sometimes struggle with substance abuse, sometimes have a history of trauma or other kinds of abuse, those that are concerned about their immigration status or actually, many things,” she said. “These are reaching the people who for whatever reason do not have great access to a health care provider to get their cervical cancer screening.”