The pandemic has meant that many scheduled visits to your gynecologist for regular checkups may have been put on hold. While telehealth has filled the gap for some issues, you can’t exactly get a pap smear via Zoom. And even without these unprecedented circumstances, the number of women getting regular pap smears, the procedure that tests for cervical cancer, has been declining since 2000. At-home HPV tests could change that.
“At-home screening has been successful in many areas of the world,” says Mary Jane Minkin, MD, a gynecologist and clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University. “Although it isn’t quite as accurate as doing it through a medical vaginal exam, it’s still pretty good—and way better than not getting the test at all.”
The National Cancer Institute is planning to launch a multisite study in 2021 involving roughly 5,000 women to assess whether self-sampling at home is comparable to screening in the office by a clinician. According to Kaiser Health News, HPV self-sampling is already promoted in countries like Australia and the Netherlands.
First things first: Anyone who’s ever had a pap smear knows that they’re the opposite of comfortable. The thought of giving myself one at home sounds just a frightening as a DIY wax. However, at-home tests are much more tolerable—all you have to do is take a quick swab of your vagina.
“What bothers many women about a pap smear is inserting a speculum into the vagina and opening it up, so we can visualize the cervix,” explains Dr. Minkin. When doctors visually examine the service they’re able to look for signs of cervical cancer. The at-home tests would just test for certain cancer-causing strains of HPV, the human papillomavirus. “The swabs are very narrow, and you don’t need to insert a speculum at home, so it’s much less of a bother for many women to do the at-home test.”
Alyssa Dweck, MS, MD, FACOG, a New York-based gynecologist, explains that swabbing isn’t difficult. “Pictorial instructions or online video instructions would make this an easy task for many,” she says. “After all, women do at-home pregnancy tests, urine testing for infection, and use tampons.”
There are currently at-home HPV tests available from Nurx and Everlywell. Dr. Minkin says that because the National Cancer Institute is backing this study, it’s likely that the testing kits would be free once they come out. The Nurx test, for example, costs $49 if you have insurance or $79 without it.
“A reliable and accurate at-home HPV test would be a welcome addition to current screening but may not replace traditional practitioner-performed pap smear and HPV test,” says Dr. Dweck. An HPV test would just test for the presence of HPV. A pap smear, however, takes cervix cells to be looked at under the microscope for pre-cancer or cancerous abnormalities.
Dr. Dweck explains that current guidelines recommend that women aged 21 to 29 get a pap smear every three years without an HPV test. “HPV testing is not done on women less than 30 years old, the thought being that most younger women with HPV will actually clear the virus spontaneously and it will lay dormant and also because vaccination for HPV is available and will hopefully diminish risk significantly,” says Dr. Dweck.
For women age 30 to 65, screening is recommended every three years with a pap test alone, every five years, every five years with high-risk HPV testing alone, or every five years with Pap and high-risk HPV cotesting, according to the National Cancer Institute. If you read that sentence multiple times and are still unsure what it said, same. Dr. Dweck believes that these cumbersome guidelines are part of the reason why women aren’t getting regular HPV testing. She also attributes the decline in screening to lack of insurance or knowledge about the importance of screening.
Testing is so important because cervical cancer is largely preventable.
“An HPV test, often tested along with the pap smear, screens for human papillomavirus which causes most cases of cervical cancer as well as multiple other cancers,” says Dr. Dweck. “A positive HPV test and/or abnormal pap smear helps to identify those women who might be at risk for cervical and other types of cancer so heightened surveillance and-or treatment can be accomplished.”
Dr. Minkin suggests that even those who are vaccinated against HPV continue to get regular checkups.
“HPV is the cause of almost all cervical cancer. Fortunately, we do have a wonderful vaccine available to help prevent it, and it does prevent about 90 percent of cervical cancers—but not 100 percent,” says Dr. Minkin. “And despite its excellent efficacy, many women in this country aren’t immunized, so it’s still very important to get screened. Because if we do find a precancerous abnormality on the cervix, we can cure the patient, no problem. It’s those undiagnosed cases that cause women problems.”
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