Now the virus that causes cervical cancer can be detected through a home kit
By Deborah Jeanne Sergeant
The FDA has recently approved a home HPV screening kit.
Women can collect the sample at home and send it to a lab for analysis.
The test can detect several types of human papillomavirus (HPV) which cause between 95% and 99% of cervical cancers.
If caught early, cervical cancer can be highly treatable. One of the challenges with catching cervical cancer is getting patients to undergo regular screenings.
“I understand it’s a very intimate test and I can understand that they don’t want to do something like that,” said Corey Meyn, nurse practitioner at URMC Urgent Care in Seneca Falls and Geneva. “The home test is better than nothing at all but not a replacement for chatting with the provider or OB-GYN.”
Annual cervical exam appointments also typically include other screenings and can provide an opportunity to ask providers questions. Providers also ask about other health issues related to the patient’s age and health history.
“I’m excited about the different options we’re getting as a society for cervical cancer screening as it helps people who don’t routinely get screening,” said physician Jordana Gilman, board certified in women’s health and assistant professor of clinical OB-GYN with Highland Hospital.
Gilman said that standard Pap smears offer gynecologists more information. Plus, they can provide exams under anesthesia for women who struggle to tolerate the procedure, which can be painful as the care provider inserts a speculum into the vagina and scrapes cells from the cervix. Women must splay their legs with their feet in stirrups while wearing only a short gown on their upper halves. It’s not a visit to look forward to.
As far as affordability, most women can get a Pap smear free through Medicaid or other health insurance, as is typical for preventive health. But for those who make too much money to qualify for Medicaid and do not have employer-funded health insurance, the $99 home kit can offer affordable access to annual HPV screening.
Gilman recommended HPV screening for those aged 21 to 65. But any age should maintain regular check-ups and also reach out to a provider in case of issues such as changes in menstruation or anything else worrisome.
Physician Erica A. Bostick and physician Merielle Stephens, both at the University of Rochester Medical Center, view home screening for HPV as a good tool for expanding access.
“The biggest positive is it will really expand access for patients who don’t see a provider for pelvic exams,” Stephens said. “There’s a host of people we don’t screen for a lot of reasons.”
Bostick added, “This concept isn’t new as there a few tests for other things patients can collect at home. You can list a host of barriers to get someone into the office, like transportation. If you live in a rural area, seeing a provider can be a half-day affair.
“This opens the door for a lot of folks to have a primary screening test. But if it’s positive, next steps need to happen.”
The screening kits provide users with positive results referrals to local providers for follow-up.
Bostick noted that the home screening kit looks for varieties of HPV alone and not other issues.
Stephens said that her office uses a patient collection kit in the office, but the same kit may be used at home.
“It stands to reason that patients could do it,” she said. “There’s nothing magical about being in the bathroom in my office compared with your home.”
Bostick feels that the kits “fit nicely with our goal to make our care in women’s health more patient-centered. Improving pain management has been in the news for patients getting IUDs. That is us trying to shift our framing to what is best for the patient. This is another move in that direction.”
Although the kits can further broaden access, Kate Ott, registered nurse, master’s in public health and public health director for Ontario County Public Health, reminds women that screening for HPV represents only one part of their healthcare.
“During an exam with a competent provider, a woman will have a breast exam and visual examination of exposed skin and the labia, vagina and anus,” Ott said. “These areas are difficult for women to see without a mirror and having a professional take a look is good practice. They can rule out structural abnormalities, skin cancers, labial-vaginal cancers, etc.
“Additionally, the provider will do a bi-manual exam to feel the size of the uterus and ovaries. This is very important to rule out uterine or ovarian enlargement — tumor, pregnancy, fibroids, etcetera — or pain. For some women, this would include a rectal exam to help rule out colorectal cancer and bladder or rectal prolapse.
“Finally, it is at these visits that family planning and birth control are discussed and STI testing is completed based on age, risk factors and sexual practices.”
Ott recommends incorporating HPV vaccine into children’s healthcare, including boys, between 9 and 12, well before sexual activity begins. Most HPV transmits sexually and can affect males as well. The vaccine is approved for adults up to age 45.