A new study suggests distributing self-testing kits by mail helps bring effective testing to underserved populations and makes it easier for women to get tested on their own time.
In the United States, 25% of women either delay or forego recommended cervical cancer screening, and it’s easy to understand why. Traveling to the doctor’s office is time intensive, requiring that you first book an appointment, then manage transportation and all the activities and errands you might miss while you’re there, including time off of work.
What’s more, getting screened can be scary. You don’t tend to hear women raving about their latest experience with a pelvic exam or pap test. Not to mention that the act of getting screened forces us to admit an uncomfortable truth: Everyone, ourselves included, runs the risk of getting cancer.
But the fact that cervical cancer screening is time consuming and scary doesn’t change the fact that it’s the right thing to do for your health. Consider this: For anyone with a clean bill of health, it feels great to be reassured that you’re cancer free. And for anyone who might receive hard news, that news can never come a moment too soon—early diagnosis often means the difference between survival and death.
Now, researchers are measuring the plausibility of a new screening method that’s based on seemingly simple logic: If you remove the inconvenient barriers preventing or stalling many women from receiving their recommended cervical cancer screening, more women will get screened and outcomes for women with cervical cancer might improve.
So what is this method? Sending out Human Papilloma Virus (HPV) self-sampling tests via standard mail. Results are promising. In a randomized clinical trial including 19,851 women, 26% were screened after receiving an HPV kit in the mail versus just 17% who received mailed invitations to visit a doctor’s office.
What’s the Connection Between HPV and Cervical Cancer?
To understand why HPV screening and cervical cancer prevention are so closely linked, it’s important to understand a few fundamental facts about HPV, an incurable viral infection that gets passed through sexual or other types of skin-to-skin contact. HPV is the most common sexually transmitted infection in the United States – so common, in fact, that 80% of women will get at least one type of the virus in their lifetime, according to the US Office on Women’s Health, a division of the US Department of Health and Human Services (HHS).
Despite being incurable, most men and women have no symptoms or health problems spurring from HPV. However, certain types of HPV can cause warts and others can cause cancer or precancerous lesions, which are abnormal growths that can eventually turn into cancer.
HPV causes nearly all cervical cancers, and of the cervical cancers related to HPV, about 70% are caused by HPV-16 and HPV-18 (there are about 150 different types of the virus). Although almost all cervical cancers are caused by HPV, it’s important to remember that most genital HPV infections will not cause cancer, according to the American Society of Clinical Oncology (ASCO).
Why Is HPV Screening So Important in Preventing Cervical Cancer?
HPV tests are one of a handful of ways to prevent cervical cancer and are typically reserved for women 30 and older. The current method of testing for HPV includes visiting a doctor and having the care team collect a cervical cell sample, which is tested for the types of HPV most commonly linked to cervical cancer. Early detection followed by treatment of any detected precancerous lesions can prevent the majority of cervical cancers.
Despite these preventive possibilities, many women still don’t participate in screening programs because of lack of awareness, access, opportunity and many other reasons. That’s why researchers led by Rachel L Winer, PhD, MPH of the University of Washington HPV Research Group are distributing at-home HPV tests by mail—they hypothesized that mailing self-sampling HPV kits to underscreened women could increase participation in screening programs compared with mailed invitations for screening at a doctor’s office.
If more women are willing to participate in screening from the comfort of their own homes, researchers posited that HPV and precancer detection rates might increase. This in turn could result in more women receiving the treatments they need to prevent cervical cancer earlier, when treatment is most effective.
Did Mailed At-Home HPV Tests Increase Screening Participation?
Yes. Study participants were broken into two groups. The first group received at-home testing kits in the mail, and the second group received mailed reminders to attend screening at a doctor’s office. In the first group where women received at-home testing kits, 26% were screened. In the second group that received reminders, just 17% were screened.
Test results were encouraging, but there is still more work to be done before the efficacy of at-home tests can be widely proven. For example, while Winer and colleagues’ study showed that screening uptake could be improved, there is some disagreement as to whether the increase was sizable enough to warrant a change in testing methods. Similarly, there was no statistically significant difference in the number of cases of precancers detected or treated following the screening.
“Overall, this impressive randomized clinical trial demonstrated that implementation of a home HPV screening program is feasible for large health care systems. The strategy especially merits further research in populations with lower resources and higher disease prevalence,” wrote three physicians in an editorial response
to the study. “Of course, home HPV testing can only be a part of the solution to cervical cancer prevention and should be implemented in tandem with continued prevention strategies, such as HPV vaccination administration in all populations.”
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