The American Cancer Society has endorsed self-collected vaginal samples for cervical cancer screening — a change medical experts say will help expand access and improve detection.
The updated ACS recommendations, released Thursday, reflect advancements in disease detection and access to screening options in the United States. The guidelines say self-collection to test for human papillomavirus, or HPV, a sexually transmitted infection that causes nearly all cervical cancer cases, is an acceptable option. But clinician-collected cervical samples are still preferred. The recommendations also offer new guidance on when people can stop being screened for cervical cancer.
Self-collection could be “a game changer” for increasing screening, said Jane Montealegre, an associate professor in the department of behavioral sciences at the University of Texas MD Anderson Cancer Center.
What the guidelines say
About 13,000 new cases of cervical cancer are diagnosed in the United States every year, and about 4,000 people die, according to the Centers for Disease Control and Prevention. While the ACS notes that cervical cancer screening programs have been successful at dramatically decreasing cancer incidence by more than half since the mid-1970s, data shows that screening rates have declinedin the past 20 years.
The updated recommendations “are made possible as we transform our approach to screening for cervical cancer, primarily through research advancements and the development of self-collection tools to make sure everyone who needs screening is able to access it,” said Robert Smith, ACS senior vice president of early cancer detection science.
A self-collected test could be a good option for people who aren’t comfortable getting a pelvic exam or don’t have access to one, Montealegre said. She added that most insurance should cover HPV testing and that these tests would qualify.
“A lot of people have many, many insurmountable barriers to coming in to see their provider for screening,” said Montealegre, who has studied self-collection and screening. “This really is a way to double screening participation among women and other individuals who need to get screened who haven’t been able to do so previously.”
Under the ACS guidelines, average-risk people should start screening at 25 years old. When clinician-collected cervical samples are used for HPV testing, repeat screening is recommended every five years for those with a negative test. Self-collected vaginal swabs should be tested every three years.
If testing for just HPV is not available, the ACS recommends people ages 25 to 65 should be screened with a combination of an HPV test and a Pap smear every five years, or just a Pap smear every three years. The updated guidelines also say many women with a recent history of consecutively negative tests can stop testing at age 65.
“The changes are significant, as now patients have another cancer screening option, alongside colon cancer screening, they can do at home or a location of their choosing,” said Arif Kamal, ACS chief patient officer. “This really speaks to making cancer screening less logistically complex and more accessible.”
How self collection works
Because at-home screening tools are still limited, a self-collected vaginal swab is typically done in a clinical setting, such as during a visit to your primary care physician or family doctor, Montealegre said. In May, the Food and Drug Administration approved the first at-home screening tool to detect cervical cancer: a wand developed by Teal Health that allows patients to self-collect a vaginal sample and mail it to a lab for testing.
The rollout of self-collection options for cervical cancer screening has been slow, Montealegre said. But she noted that the new ACS guidelines could drive uptake.
“When you have ACS provide guidelines that clearly say self-collection is possible, it’s good, and this is not an inferior screening test, I think it really gives that reassurance to everybody,” she said.
If you’re interested in self-collection, Montealegre said to ask your physician to make the option available. Make sure that whichever self-collection test you use has received FDA approval.
“If they’re not FDA-approved, I wouldn’t trust that as a valid screening test,” she said.
Having access to these tests also doesn’t mean you should stop seeing your doctor. About five to 10 percent of HPV tests are positive and require follow-up with a clinician, Kamal said.
Still, the new ACS recommendations could be the beginning of a major shift in how cervical cancer screening is conducted, Montealegre said.
The option for self-collection changes screening “from having to be something that’s done by your provider in a clinical setting to something that women are in control of,” she said. “It really is indicative of really embracing new technologies and the knowledge we have about cancer and how it’s caused to make tests more accessible.”
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