WASHINGTON, DC (August 29, 2024)—In a move welcomed by anyone who dreads getting a Pap test as a step to prevent cervical cancer, the Food and Drug Administration (FDA) recently approved HPV test self-collection conducted in health care settings. In anticipation of this approval — and with the expectation that HPV tests with at-home collection will soon get the green light from FDA, too — researchers have been identifying barriers and facilitators to use of self-collected HPV tests. Two recent articles in Women’s Health Issues report on patient and provider interest in and concerns about this new option, from studies conducted before its approval.
Testing for human papillomavirus (HPV) is recommended for cervical cancer prevention in women and other people with a cervix, beginning at age 25 or 30. Self-collected, or self-sampled, tests use a swab or brush to collect a sample from the vagina; the process is less invasive than Pap tests that involve using a speculum to collect cells from the cervix. Self-collection has the potential to make HPV testing more accessible, including to the 30% of eligible US women who do not get screened regularly, but that potential will only be realized if both patients and providers are willing to adopt it. The two new studies identify steps that could increase uptake and populations that could benefit the most.
Holly B. Fontenot, of the University of Hawaii at Manoa School of Nursing, and colleagues surveyed physicians and advanced practice providers about whether they would recommend HPV self-sampling if the FDA approved it. Of the 1,251 respondents, 33% reported that they would definitely or probably recommend it, and 29% indicated “maybe.” A subset of respondents participated in interviews with the researchers and explained their thinking. Many providers saw self-collected tests as a way to increase access to care; those who were reluctant to recommend it worried about issues such as whether patients would be able to swab correctly and the possibility of missing signs of health problems if patients did not receive regular speculum and/or pelvic exams.
“Nearly all participants agreed that self-collection was a good option for special populations including those with a history of trauma, sexual or gender minority patients, and those with concerns about speculum examinations,” Fontenot and colleagues explain.
Women veterans have a high prevalence of sexual trauma, and a study by Elisheva R. Danan, of the Minneapolis VA Healthcare System and University of Minnesota Medical School, and colleagues involved interviewing both patients and staff from the Veterans Health Administration (VA) about self-collected HPV testing. Both groups had questions about test accuracy and logistics and noted that some patients might be uncomfortable with self-collection and prefer that providers perform the tests. Both patients and staff members also pointed out that COVID-19 testing has increased people’s comfort with self-collection. Danan and co-authors write of the patient perspective:
“Sexual assault and subsequent posttraumatic stress symptoms made some veterans uncomfortable with invasive examinations. Self-collection would allow them to take charge of their own health again—it would return control over cervical cancer screening to the patient.”
Both articles highlight the importance of materials for providers that address common questions, such as concerns about the accuracy of self-collected samples. Fontenot and co-authors also note that providers would like to see endorsement and guidelines from professional organizations, and Danan and colleagues discuss the need for patient-facing materials: “Providing transparent patient education about test accuracy for self-collected testing compared with clinician-collected testing can help build trust.”
Both articles have been published online as articles in press and are free to read at the Women’s Health Issues website until October 31, 2024:
Fontenot et al., 2024: Health Care Provider Willingness to Recommend Self-collected Tests for Human Papillomavirus: A Mixed Methods Examination of Associated Factors
Danan et al., 2024: “It Feels Like Health Care With the Patient in Mind”: VA Patient and Staff Perspectives on Self-Collected HPV Testing
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health at the George Washington University.