Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, responsible for over 99% of cervical cancers. Traditionally, HPV screening involves a speculum-based exam, a procedure that many patients find uncomfortable, particularly those with physical disabilities.
In a breakthrough, researchers from the University of Michigan have demonstrated in two studies that self-sampling for HPV detection is as effective as the traditional speculum-based method. These studies, published in Preventive Medicine Reports and JAMA Network Open, mark the first U.S. demonstration of self-sampling as a reliable alternative.
HPV is often asymptomatic, and many individuals are unaware they have contracted the virus. By age 50, roughly 80% of women will have been infected with HPV at some point. While most HPV infections resolve within two years due to the body’s immune response, persistent infections can increase the risk of cervical cancer.
Currently, cervical cancer screening and HPV testing are recommended every 3 to 5 years for women beginning at age 25. Co-testing for both HPV and cervical cancer is deemed unnecessary, as HPV testing alone yields the same results in identifying cancer and its precursors.
According to Dr. Diane Harper, the study’s senior author and a professor at the University of Michigan, “Co-testing for HPV and cervical cancer is not useful in any meaningful way. You can find the same occurrence of cervical cancer and its precursors by just testing for HPV alone.”
The physical and emotional strain of speculum-based exams is also a significant concern. Dr. Harper notes that “half of the women in the U.S. who have cervical cancer did not undergo a screening test in the past ten years. We should try to make it a more comfortable experience.”
Countries like Sweden, Australia, and the Netherlands that have embraced self-sampling for HPV have seen a decline in cervical cancer rates. This research aims to bring similar results to the U.S., comparing self-sampling to the traditional speculum-based method.
The University of Michigan study involved 193 participants, aged 25 to 65, who were either undergoing routine screenings or were at risk for cervical cancer. Participants used vaginal swabs for self-sampling, which were then sent to a laboratory, and also underwent speculum exams. All samples were tested for 15 high-risk types of HPV. The results showed that vaginal swabs were as effective as speculum exams for HPV detection.
Dr. Harper emphasized, “We found that using swabs is equivalent to speculum-based collection.” The study’s results align with global data on HPV prevalence, supporting the effectiveness of vaginal swabs for HPV screening.
Self-sampling also presents an opportunity to improve screening for women with physical disabilities, who often face barriers such as inaccessible healthcare facilities or difficulty with speculum-based exams. Dr. Susan Ernst, a clinical associate professor at the University of Michigan and co-author of the study, explains, “Women with physical disabilities have lower rates of cervical cancer screening due to several barriers.”
The study also focused on 56 women with physical disabilities to assess their preferences. Many participants described speculum exams as “cold,” “traumatizing,” and “invasive.” In contrast, self-sampling was described as “simple,” “comfortable,” and “feasible.”
Corrianne Norrid, a medical student and co-first author of the study, remarked, “I was already aware that speculum-based exams can sometimes be unpleasant. However, some of the experiences the participants shared with us were truly horrifying.”
Dr. Harper concluded, “The swabs cannot replace having a conversation with your doctor. However, it can save the vast majority of women from getting unnecessary speculum tests.”
The researchers are collaborating with U-M Health to make self-sampling the primary method for cervical cancer screening in their clinics, aiming to use these findings to inform educational and promotional efforts nationwide. Dr. Harper added, “This is a great example of how multiple disciplines at Michigan Medicine work together. Our next goal is to find a cure for HPV.”
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