HPV tests with self-collection: What to know

This month, the Food and Drug Administration (FDA) approved self-collection to test for HPV, the virus that causes cervical cancer. As a researcher who has spent my career studying how to make cancer screening more accessible, especially for underserved populations, I am unbelievably excited.

HPV, or the human papillomavirus, is a group of more than 100 viruses that can be passed from person to person. It is very common; most humans will more than likely have HPV at some point in our lives. Most of us will clear HPV infections on our own through our body's natural immunity. However, some of us will have persistent infections that can lead to changes in our cells. The persistence of certain more aggressive types of the virus can put some of us at higher risk for cervical cancer and other HPV-associated cancers.

Cervical cancer and other HPV-associated cancers can be prevented by getting the HPV vaccine early in life. Additionally, cervical cancer can be prevented through screening, which allows precancerous changes in the cervix to be found and treated early, before they become cancer. In the United States, screening is usually performed by women’s health professionals using Pap and HPV tests. But now, newly approved self-collection methods are making it possible for women and people with a cervix to take their own samples in a broad range of health care settings, including primary care and mobile health clinics. This offers an unprecedented opportunity to expand access and provide women with a more widely acceptable option for staying up to date with regular screening.  

Here, I share more about how self-collection is performed, who is eligible and what to know about the future of HPV screening.

How do HPV tests with self-collection work?

HPV tests work by detecting high-risk strains of the virus that may be present in cells in the cervix or the vagina. Samples for HPV testing are usually collected during a pelvic exam.  

Now, there are a couple of devices and tests that were approved by the FDA for self-collection. One device is a swab that looks like a large Q-tip. Another looks similar to a tampon. Both are inserted into the vagina and rotated a couple of times to take a sample. The sample is then sent to a lab for HPV testing with an approved test.

Self-collection is currently approved for use in health care settings. While there is still a lot of work to implement self-collection, the vision is that self-collection kits will be available in health care settings where women can go to a restroom on site to collect a sample.

If the test comes back positive, it is very important that the patient get additional tests to see if the virus has caused any changes in the cervix that might progress to cancer. This usually means receiving a Pap test or a diagnostic test called a colposcopy.

Who is eligible for HPV test self-collection?

Right now, the FDA has approved self-collection as an alternative way to collect samples for HPV testing in situations where a pelvic exam isn’t recommended or otherwise possible.

Self-collection may be used in situations in which a pelvic exam is not a good option due to lack of access, which is a significant barrier to cervical cancer screening. Many people don’t have access to traditional cervical cancer screening tests for a variety of reasons. These reasons might include:

• Not having insurance
• Living in a medically underserved area
• Lacking the time, transportation or childcare needed for an appointment

Self-collection may also be used in situations in which a pelvic exam is not an acceptable option for a patient. Some reasons a pelvic exam might not be possible for a patient include:

• Past trauma
• Not identifying as women (such as in the case of transgender men)
• Religious and cultural beliefs
• Discomfort and anxiety

In my research, we’ve found that under-screened people visit their health care settings for primary or emergency care, but not specifically for screenings with a women's health professional. For these populations, self-collection will allow them to be screened while they address other health care needs. Being able to self-collect while waiting to see a provider for another health issue allows them to do screening tests that would otherwise require an entirely different appointment with a more specialized provider like a gynecologist. 

While self-collection is currently indicated in situations when a pelvic exam can’t be performed, I think self-collection will be used a lot more broadly in the future. I think many women will be in favor of having the ability to perform screening themselves.

Are self-collection results as accurate as the results a health care provider gets?

Yes. Self-collection has been implemented very widely internationally. Hundreds of thousands of women across the globe have participated in self-collection studies, both as research and as full-blown implementation programs. For example, in many northern European countries, self-collection is standard of care and available to everyone.

We know from data from all around the globe that the accuracy of the tests is identical.

Who needs HPV screening?

HPV testing is available for women ages 25 and older. Here are the cervical cancer screening exams MD Anderson recommends women get based on their age.

Women ages 21 to 29:

• A Pap test every three years beginning at 21, or
• An HPV test every 5 years beginning at 25

Women ages 30 to 64: 

• An HPV test alongside an optional Pap test every 5 years, or
• A Pap test every 3 years

Women ages 65 and older:

• Screening can be discontinued as long as previous screening tests have been negative. Make this decision with your care team.

While screening and early treatment can prevent cervical cancer, there are no widespread screening tests for the other HPV-associated cancers, such as oropharyngeal (throat) cancer and anal cancer. This makes HPV vaccination critical for preventive HPV-associated cancers.

Kids and teens should get the HPV vaccine starting at age 9 to protect against six HPV-associated cancers. Catch-up vaccination can be done through age 26, and adults ages 27 to 45 can speak with their doctor about possibly getting vaccinated. 

Is there anything else people should know about the future of HPV testing?

Here are a few more things to know about the future of HPV testing.

At-home self-collection could be approved in the future

Primary HPV testing with self-collection is approved for use in health care settings now. However, there are ongoing trials that will provide the FDA with data that could lead to the approval of at-home self-collection.

In the meantime, clinic-based self-collection is a huge step forward. It will enable more people to access screening and cervical disease management.  

Cervical cancer screening is a process, not a test

It is crucial that anyone who tests positive for HPV has easy access to follow-up care to help manage HPV and the risk of cervical cancer.  

We have the opportunity to eliminate cervical cancer

We have a very effective vaccine against HPV. Now, we have screening tools that expand access to screening and management of cervical disease. Cervical cancer elimination is within our reach and can help achieve MD Anderson’s goal of Making Cancer History®.  

Request an appointment at MD Anderson online or call 1-833-924-4159.