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News — LOS ANGELES (Jan. 6, 2025) -- There are several medical tests where patients collect their own samples: nasal swabs for COVID-19, urine samples for pregnancy, stool tests for colorectal cancer. Now, a test for high-risk HPV, the type of human papillomavirus that can cause cervical cancer, has been added to the list.

Traditional cervical cancer screening is done during a pelvic exam. As an alternative, the U.S. Preventive Services Task Force published new draft guidance in December stating that women may self-collect vaginal samples for HPV testing at their clinician’s office. Experts believe this could improve screening rates and detect more cases of cervical precancers and cancers.

“I think this testing is going to make it much easier for women to ensure they are up to date with cervical cancer screening, said , chief medical officer of Cedars-Sinai Medical Network. “Many women see primary care physicians who may not routinely perform pelvic exams, and having to make a separate visit to a gynecologist can be a barrier for patients. Cervical cancer is so preventable, given what we now know about how to manage early abnormalities, that every case is a tragedy.” 

January is Cervical Cancer Awareness Month, and gynecological oncologist , medical director of the Cancer Clinical Trials Office at , sat down with the Cedars-Sinai Â鶹´«Ã½room to discuss this new option.

First, what is the difference between HPV and high-risk HPV?

HPV is the most common sexually transmitted infection (STI) in the U.S. HPV is transmitted through skin-to-skin contact, usually during sex with someone who has the virus. There are more than 200 types of HPV, but not all cause cancer. Certain types, which we call high-risk HPV, can avoid the body’s immune system and linger, causing damage to cells that can then cause those cells to become cancerous.

How does this type of self-collection work?

The kits currently approved by the Food and Drug Administration are for collection in a clinician’s office, so most people would likely receive them from their primary care provider. The patient is given an instruction sheet and a collection swab to be inserted into the vagina. Then the patient goes into the restroom to collect their sample. The patient returns the sample to the clinician, who sends it to the lab for evaluation. It isn’t at all complicated. If you can insert a tampon, you can do this.

What are the potential benefits for patients?

These tests make HPV screening much easier for patients who cannot—or do not want to—make it in to see a gynecologist for whatever reason. Maybe they don’t have access to a gynecologist, or have experienced trauma that makes a pelvic exam especially difficult, or their schedule is so busy that their visit keeps getting put off.

If they make it in to see their primary caregiver, they can do one of these HPV tests right there. If they get a negative result—meaning HPV is not present—they will not need another test for cervical cancer for 5 years. If they get a positive result, they need to prioritize seeing a gynecologist for further screening. I think these tests will increase screening and help us identify people with high-risk HPV and prevent deaths from cervical cancer.

Is there a similar test to detect high-risk HPV in men?

No. Currently, there is no standard medical test for high-risk HPV, which can also lead to penile, anal and oral cancers, in men. However, there are other tests that can detect HPV-caused cancer in men.

Why is HPV screening so important?

Caught early, cervical cancer is completely curable. Cervical cancer caught late is very difficult and often impossible to cure. Pap tests give us a fantastic ability to test for precancerous changes to the cervix, which we can then eliminate to prevent cancer.

HPV, it turns out, is the predictor of those precancerous changes, and precancer doesn’t usually develop unless HPV is present.

We have very good vaccines against HPV available and we strongly recommend that children are vaccinated beginning at age 9. For those not vaccinated as children, we recommend that teens, young adults, and even some adults up to age 45 receive the HPV vaccine in consultation with their doctors. For people who are infected with high-risk HPV, we can recommend things to help improve immune responsiveness. For example, smoking and HPV are a very high-risk combination, so if we know someone is infected, we will advise them to quit right away.

What do we know about how accurate the tests are?

The kits were approved by the FDA in May for self-collection in a clinician’s office, and we know that they work very well. They are similar to the tests gynecologists use to screen patients for high-risk HPV. Eventually, self-collection from home could become an option.

Are there potential downsides to self-collection?

The potential downsides are fairly small. If people take this test and do not visit a gynecologist, they aren’t being assessed for other gynecologic conditions that might need to be treated. During a pelvic exam, we can detect large masses. We can detect painful areas. We can detect nodules. We can answer questions that the patient may have about something that may be painful or “off” or itchy or discolored, and we miss all of that information with a self-swab. For example, I will never find an early vaginal melanoma if I never look for one.

That being said, for some patients these tests will be highly valuable, and I’m hopeful that they will become widely available in primary care offices.

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