The News on Self Pap Smears

The last time Anna had a Pap smear was six years ago. When she talked with her sister about it, Anna wasn’t quite sure why she had waited so long. She was very busy juggling her job, two young boys and other family obligations, but she hadn’t been to see her own doctor. She also remembered that her two previous Pap tests were uncomfortable and sometimes she just felt embarrassed with the whole procedure. She knew she needed to have the exam for her health, but obstacles, both physical and mental, kept getting in her way.

Each year in the United States, about 4,000 women die of cervical cancer, and more than 11,000 new cases are diagnosed, according to the Centers for Disease Control and Prevention. Half of these cases are detected in women who have never been screened, and 10 percent come from those who haven’t been screened in the past five years. Apprehension about medical tests, anxiety about pain, financial costs, time constraints and not understanding the importance of screenings are some of the biggest reasons women skip or delay their screenings.

In May 2024, the Food and Drug Administration approved two different tests that detect cancer-causing types of human papillomavirus, or HPV, in the cervix. Both tests are used as part of screening for cervical cancer. Under these expanded approvals, women now have the option of collecting their own vaginal sample in a healthcare setting for HPV testing.

While there is still work needed to implement the process, the vision is that self-collection kits will be extremely valuable in the healthcare world. Similar to how patients collect their urine samples, women can now collect their vaginal samples in a doctor’s office, urgent care or pharmacy clinic.

How Does a Self Pap Work?
Eligible patients who choose to self-collect can take the test in a private area within the medical practice. The patient will take a sample by inserting a swab or brush a few centimeters into the vagina and rotating it for approximately 10 to 30 seconds. The swab is then sent to a lab for processing that will relay results to the doctor’s office, who will then follow up with the patient.

Who Is a Candidate?
Many people are not comfortable with the pelvic exam required for a traditional Pap smear for reasons such as traumatic issues, past negative experiences and religious or social preferences. Improper insurance coverage and living in an underserved medical area may also deter people from getting a pelvic exam from a physician. Experts say that by having a less-intrusive option, more people will be screened for HPV and potentially prevent cervical cancer.

Who is not a good candidate? Any patient who is experiencing unusual bleeding, pain or discharge should not do self-testing. Since the current recommendations are for self-collection to be used under the supervision of a provider, the patient can assess the information to better understand the benefits and limitations. Patients should speak to their doctor about what will work best for them.

Is Self-Pap Accurate?
Are self-collection screenings accurate? Yes, experts say. Internationally, self-collection has already been implemented and studies show that the accuracy of the tests is identical to a doctor’s Pap smears. In many northern European countries, self-collection is standard of care and available to everyone.

Moving Forward
The future of Pap self-testing looks promising. The hope is that it will increase screening participation rates, particularly among groups who may be under screened, and reduce the occurrence of a preventable cancer. Experts say a much wider set of future approvals is on the horizon, including self-collection in people’s own homes, once more evidence is gathered.

The National Cancer Institute has launched the Last Mile initiative, a nationwide clinical trial nicknamed SHIP, for self-collection for HPV testing to improve cervical cancer prevention. The trial will test whether self-collection in the home setting works as well as collection by a clinician in a health care setting. If approved, offering home-based sample collection as an option may expand access to screenings even further. The CDC still recommends women take other steps to help prevent cervical cancer, such as vaccination against HPV, smoking cessation, condoms and doctor visits to discuss abnormal results.

Regardless of where the testing takes place, cervical cancer screening remains important; signs and symptoms of the disease are often hard to detect. Having the option for self-collection could encourage more people to receive timely, necessary testing and is a big step forward for patients and their caregivers. It offers women another option to screen for cervical cancer while still giving them the benefit of speaking with their doctor to discuss other health issues that are part of an annual exam.

Sources: cancer.gov, cdc.gov, mdanderson.org, healthdirect.gov.au and cnn.com.