HPV self-collection: A step closer to eliminating cervical cancer

Screening and early detection, as well as the introduction of a human papillomavirus (HPV) vaccine, have fuelled transformative strides in decreasing the burden of cervical cancer for women and people with a cervix.

Cervical cancer is often highly treatable, with a five-year relative survival rate of 91% for localised, early-stage disease.¹ Because it is also one of the few cancers that can be largely prevented through appropriate vaccination and screening, eliminating cervical cancer is possible – but only through collectively taking the steps necessary to achieve this goal.

While rates of cervical cancer incidence and death have been declining for decades in many parts of the world, not all populations have seen equal improvement. More than half of US women diagnosed with the disease have never been screened or have only been screened infrequently, contributing to persistent disparities in cervical cancer morbidity and mortality.²

Papanicolaou (Pap) testing and screening for high-risk strains of HPV, which cause roughly 95% of cervical cancer cases globally, can help identify those at risk of developing the disease and enable early detection and intervention.³ Vaccination against HPV can also contribute to prevention efforts, but as of 2022 less than 40% of US children aged 9-17 had received one or more HPV vaccine doses.⁴ Concerted efforts to overcome barriers to vaccination, timely and accessible screening, and early diagnosis will be vital to achieving a future where no one dies from cervical cancer.

Reaching the underserved and underscreened

In the United States, certain groups are disproportionately impacted by barriers to screening, presenting a significant obstacle to the goal of eliminating cervical cancer as a public health issue. For example, a 2019 study found that Asian and Hispanic women were more likely than non-Hispanic White women to be overdue for screening.⁵ In the study, disparities in timely screening were also observed among women living in rural areas, those lacking insurance, and those identifying as lesbian, gay, bisexual, or queer (LGBQ+).

These disparities translate to meaningful differences in cervical cancer incidence and outcomes, with rural, low-income, racial/ethnic minority, and uninsured populations most adversely affected.^6,7,8,9 Black women are more likely to receive an advanced-stage cervical cancer diagnosis than White women, and Black and Hispanic/Latina women are more likely to die of the disease than White women.^9,10

Current cervical cancer screening guidelines by the US Preventive Services Task Force include the options of cervical cytology (Pap) alone, high-risk HPV screening alone, or Pap in combination with HPV (co-testing) depending on a woman’s age.¹¹ While achieving equitable access to regular cervical cancer screening is a complex and multifaceted issue, one clear area for innovation is how testing takes place.

Current Pap and HPV testing procedures can be a source of stress and discomfort, typically requiring a pelvic exam to allow a healthcare provider to brush the cervix for a cell sample. This invasive process can be uncomfortable for many people, particularly those with a history of sexual trauma, transgender men, women with disabilities, and women with cultural or religious concerns.^12,13,14,15 For those wanting to avoid this experience, it can be easy to fall behind on regular screening.

Putting women in control with HPV self-collection

HPV self-collection tests represent a major milestone in overcoming barriers to access and improving the experience of women undergoing cervical cancer screening. Using a self-collection test, a woman or person with a cervix can independently take their own vaginal sample within a healthcare setting, without the need for a speculum, “stirrups”, or pelvic exam. The collected sample is then submitted to a lab to be assessed for the strains of HPV most likely to cause cancer. For example, following its approval in countries such as Australia, Denmark, and the Netherlands in 2022, Roche Diagnostics’ HPV self-collection solution was among the first to be approved by the US Food and Drug Administration in 2024.

This new paradigm of care increases access to cervical cancer screening and, in turn, increases the likelihood of early detection of this largely preventable cancer. Self-collection extends HPV testing to a wider range of healthcare settings, such as community clinics in rural areas. In these settings, pelvic examinations may not be routinely performed, but healthcare professionals are present to direct patients through the test. The tests can also help women take greater control of their health, opening a new path to care for those hesitant to undergo a pelvic exam.

One key thread in a tapestry of cervical cancer care

While more accessible HPV testing through self-collection is a promising advance toward eliminating cervical cancer, it is not the only solution. HPV self-collection is a valuable addition to a full continuum of diagnostics that enable appropriate and timely answers and interventions for all women undergoing cervical screening. Whether collected by the patient or their clinician, an HPV test provides a first step in identifying women with high-risk strains requiring follow-up. Once a patient is in the clinic or office, further triage testing can be performed using dual stain cytology testing, which identifies cellular biomarkers indicative of a transforming HPV infection. Dual stain provides improved cervical cancer risk stratification than Pap cytology and empowers clinicians to take informed next steps. This reduces unnecessary referrals to colposcopy, can provide assurance to patients that it is safe to retest at a subsequent appointment, and directs timely intervention for those who need it.

Over the past several decades, an improved understanding of cervical cancer risk, as well as the broad implementation of screening and HPV vaccination, have changed the landscape for how we identify and manage this disease. We have already come a long way in reducing cervical cancer mortality since the implementation of Pap testing as part of screening, but we can’t stop now.

As with countless other public health issues, persistent disparities remain in who accesses these preventative measures and who bears the greatest burden of cervical cancer morbidity and mortality. How can we reach the more than 50% of cervical cancer patients who have either never been screened or have been underscreened? How can we ensure that those identified to be at high risk of cervical cancer return for follow-up and can access the care they need without falling through the cracks?

Without equitable access, we can’t reach equitable outcomes. While HPV self-collection testing in a healthcare setting is a major breakthrough for cervical cancer prevention, there’s still work to be done. Making screening more accessible and inclusive to all populations, as well as ensuring people receive necessary follow-up care when risk is identified, will be key in bridging the remaining gaps in cervical cancer incidence and outcomes. A world where no one dies from this disease is within reach. By providing a new way to empower women to take their health into their own hands, we’re getting closer to that goal.

Author’s note - While we use the term "women" throughout this article, we acknowledge that people who identify as men, non-binary, gender non-conforming, genderqueer, and many other identities can have a cervix and should be offered cervical cancer screening.