New American Cancer Society guidelines back HPV self-testing as a more effective way of detecting cervical cancer.
The American Cancer Society updated its cervical cancer screening recommendations last month to expand access to testing, including the option for self-testing for human papillomavirus, or HPV, the virus responsible for nearly all cervical cancer cases. The new guidelines also stated individuals with average risk who have negative test results at ages 60 and 65 can safely stop screening.
However, the guidelines emphasize that individuals who don’t meet these criteria should continue to screen until they have two negative tests at the recommended interval, even if older than age 65, since many cervical cancers occur in elderly women who are not up to date with screening.
Andrew Wolf, MD, a primary care physician at UVA Health and a co-author of the new recommendations, said the goal of the self-testing recommendation is to lower barriers to screening, as about a quarter of women in the U.S. are currently not up to date with cervical cancer screening – a figure that increases to about half in some rural regions.
UVA physician Andrew Wolf, MD, is a co-author of the new guidelines and said the new Teal Wand allows the cancer to be detected and prevented, not just treated.
“Since our guideline update in 2020, there have been a number of studies showing the effectiveness of self-testing in detecting HPV,” he said. “If we can detect that, then we have a way of finding the risk factor for cervical cancer before cervical cancer starts – actually preventing cancer, not just detecting cancer.”
Last May, the Food and Drug Administration approved the country’s first at-home HPV screening device, designed as an alternative to the traditional Pap smear some patients find painful.
The Teal Wand, named after the company Teal Health that designed it, allows users to collect a vaginal swab sample at home and then mail it to a lab for testing. It’s available in Virginia and more than half of U.S. states. In addition, there are several HPV self-tests available designed to be collected by the patient in the provider’s office. Self-testing provides an alternative for individuals who are uncomfortable with pelvic examinations or have barriers to accessing routine health care.
“HPV testing is a more effective way to screen for cervical cancer and pre-cancer than Pap smears,” Wolf said. The Pap smear was invented in the 1940s and works by collecting cells from the cervix and looking for precancerous or cancerous lesions.
Wolf said Pap smears still have an important role to play, in that a positive HPV test must be followed up with a Pap smear, also known as cervical cytology. The current guidelines recommend an HPV test collected by the provider every five years as the preferred screening method, with an HPV self-test or Pap smear every three years, or co-testing with both methods every five years as acceptable alternatives.
The American Cancer Society recommends women at average risk begin screening at age 25, with clinician-collected tests every five years or self-testing every three years until the age of 65. This recommendation differs from the U.S. Preventive Services Task Force guidance, which recommends screening starting at age 21 with the Pap test only up to age 30, and then using HPV testing from age 30 to 65.
These guidelines are for average-risk women and do not apply to people who have had abnormal tests before, a recently positive HPV screening, suppressed immune systems or are living with HIV. People whose mothers were exposed to the nonsteroidal estrogen medication diethylstilbestrol are also not appropriate candidates for the self-test, Wolf said.
He stresses HPV vaccination continues to be crucial for children aged 9 to 12. “The majority of adults will be exposed to HPV at some point in their lives, and the cancers and pre-cancers caused by this virus are almost completely preventable with vaccination,” he said.
Wolf notes HPV can also lead to other conditions and types of cancers, including head and neck and anal cancers.
“Twelve thousand women are going to get cervical cancer and 4,000 of them are going to die from it in the U.S. in the next year,” Wolf said. “This is not acceptable. This is a preventable cancer if we follow these guidelines and get our children vaccinated against HPV.”
Written by Zeina Mohammed, spr2jm@virginia.edu