HPV Self-Collection Tests Dramatically Increase Cervical Cancer Screening, Study Finds

Original from: 360dx

New data published in JAMA Internal Medicine on Friday from MD Anderson Cancer Center researchers found that mail-in self-collection kits for human papillomavirus testing more than doubled cervical cancer screening participation among never- and under-screened patients.

In 2021, cervical cancer screening participation was 75 percent, with participation "notably lower among underserved populations, including women and persons with a cervix who are uninsured or publicly insured, live in rural areas, and are from racial or ethnic and sexual or gender minoritized populations," the study's authors wrote.

The researchers decided to investigate whether self-collection of samples could boost those numbers. The real-world Prospective Evaluation of Self-Testing to Increase Screening (PRESTIS) study, conducted by researchers at the University of Texas MD Anderson Cancer Center, found that 41 percent of women who received self-collection tests along with a telephone reminder participated in cervical cancer screening, while only 17 percent of those who received just a telephone reminder for clinic-based screening participated. When patient navigation support was added to self-collection tests and a telephone reminder, participation increased to 47 percent.

The study enrolled 2,474 women ages 30 to 65 from the Houston area who were overdue for cervical cancer screening, most of whom were from ethnic or racial minority groups and more than half of whom were covered by a publicly funded financial assistance program. Patients were eligible if they had no history of hysterectomy or cervical cancer, had two or more ambulatory care visits in the past five years, had no cytology in the past 3.5 years or no HPV test in the past 5.5 years, and were currently enrolled in a healthcare coverage or financial assistance plan accepted by Harris Health, the healthcare system included in the study.

The women either received the telephone reminder for clinic-based screening, the telephone reminder with a mailed self-collection kit, or the telephone reminder with a self-collection kit and a patient navigation telephone call. The telephone reminder included telling the patient about their need for screening, providing screening education, and inviting the patient to attend a clinic for screening. Patients in the self-collection groups were told on the call that they would be sent a self-collection kit — Hologic's Aptima Multitest Swab and Specimen Transport Medium — as as an alternative to clinic-based screening.

Participation was defined as attendance for clinic-based screening or return of a mailed self-collection kit within six months, the study's authors noted.

In addition to the higher rates of overall screening in the self-collection groups, the researchers found that 85 percent of women in the self-collection groups returned their kits to participate in screening.

"Too many women, especially those who are uninsured, live in rural areas or come from marginalized and underserved communities, aren’t getting screened for cervical cancer," Jane Montealegre, associate professor of Behavioral Science at MD Anderson and lead author of the study, said in a statement. "These results show that self-collection testing could be a solution to increasing access to screening and, in turn, reducing the burden of cervical cancer in the US."

The researchers noted some limitations to their study. Some patients were enrolled during the COVID-19 pandemic, which may have influenced self-collection participation rates because access to in-person health services was limited. However, the authors noted that only 20 percent of the data were collected in 2020 before full resumption of clinical services and year-by-year comparisons did not indicate temporal differences by screening modality. Other limitations included unclear reasons for participation refusal and participants declining to verify or update their mailing address.  

The study also didn't evaluate differences in the types of follow-up appointments that patients needed if they tested positive for HPV.

Interest in self-collection for sexually transmitted infection testing grew during the COVID-19 pandemic as patients were unable to come into physicians' offices or clinics for screening. Last year, Roche and Becton Dickinson were the first companies to receive US Food and Drug Administration approval for sample self-collection kits for HPV testing, and last month Teal Health received approval for its own at-home self-collection solution to be used with Roche's Cobas HPV test.

The researchers noted that "as self-collection becomes integrated in clinical workflows, it will be important to determine how mailed self-collection should be implemented alongside clinic-based self-collection."

Source: HPV Self-Collection Tests Dramatically Increase Cervical Cancer Screening, Study Finds