Longtime readers know that one issue which comes up again and again in women’s health is a paucity of data. There are a lot of reasons for this: old rules that made it difficult to include women of childbearing age in studies, few researchers with an interest in women’s health, and a lack of public and private funding. Luckily, this is changing, but it takes time to see the benefits of that change.
One bright spot, where we have seen ongoing research and steady advances for decades, is cervical cancer. The vaccine for human papilloma virus (HPV) can prevent women from getting the virus that causes cervical cancer. It is one of just a few vaccines that protect us from getting cancer.
Development of improved screening technology has also been taking place, but in a less obvious way. Instead of just looking for abnormal cells under a microscope, Pap smear samples are also tested for several strains of the HPV virus and the number of strains that are tested is continually expanded. This allows us to better pinpoint pre-cancerous changes in cells that are the most likely to grow into cancer.
Even with these advances, the experience of being screened for cervical cancer hasn’t changed much at all over the years. It involves paper sheets, stirrups, and a speculum about as technologically advanced as a pair of metal kitchen tongs. There are advantages to this type of exam. Your doctor can visually inspect the walls of your vulva, vagina, and your cervix which can help them identify issues. But for many women, the experience is so daunting that they avoid getting screened. And that’s a big problem.
Self-collection gets approved.
Just last year, the FDA approved the first cervical cancer screening tests that allowed for self-collection of the specimen. Those two tests, BD Onclarity HPV and cobas HPV, must be performed at a doctor’s office, but no speculum is required. The patient inserts a swab or brush into the vagina themselves to collect cells from the surface of the cervix. The sample is then sent to lab for processing.
Last month, the first at-home self-collection test kit for cervical cancer screening, called Teal, was approved by the FDA. Not only can you skip the speculum, but you can also collect a sample of cervical cells in the privacy of your own bathroom and send them off to the lab. Self-collection both in the doctor’s office and at home is a big step forward to improve an unpleasant experience that hadn’t changed much in more than half a century.
Is self-collection as good as a traditional Pap smear?
When we are comparing two tests, we want to know two things. First, how often do we get the same results when the results are negative? So, when a doctor collects a sample from a woman’s cervix and the result is that she does not have signs of cervical abnormalities, how often will the sample she collects herself also show that she does not have signs of cervical abnormalities?
Second, and perhaps more importantly, we want to know if the doctor-collected sample and the self-collected sample also agree when the doctor-collected sample shows that there are signs of cervical cancer. If the two tests don’t agree, that may suggest that self-collection may not identify all cases of cervical abnormalities.
One meta-analysis of the data comparing traditional cervical specimen collection by a doctor to self-collection includes 26 studies and more than 10,000 participants. The authors found that overall sample agreement was 88.7%. That means in all the tests done the doctor-collected sample had the same result as the self-collected sample nearly 89 times out of 100. If the test was negative the agreement was 91% and if the test was positive the agreement was about 85%. That means in about 15% of cases the self-collected specimen missed changes in the cells that could lead to cancer.
In a clinical trial the Teal Wand device that was approved for at-home collection performed somewhat better. Researchers found that self-collection samples agreed with physician collected samples more than 95% of the time. However, this study examined a much smaller sample of around 600 women.
Is self-collection right for you?
Currently, self-collection is only recommended for women with an average risk of cervical cancer, so if you have had a procedure such as an LEEP or a cone biopsy to remove cancerous or precancerous cells, you need to stick with traditional screening. If you have any symptoms like vaginal bleeding or discharge, you also need an examination with your doctor.
In general, screening for cervical cancer at home doesn’t replace the need for regular check-ups with your gynecologist. Doctors are looking for more than just cervical cancer in an exam. A physical exam might lead to testing for sexual transmitted infections or evaluations to look for polyps, cysts, or fibroids. Gynecologists are often the doctors who refer women for other screening tests like mammograms and bone density tests, and they are usually the doctor who will advise you regarding contraception. In short, cervical cancer screening is just one of the many things covered during a routine check-up.
That said, if fear or discomfort of a speculum exam is stopping you from getting screened for cervical cancer, self-collection maybe a great option for you. Self-collection may also be a great option for women who don’t have easy access to routine care. Ultimately, the more tools we have to keep women healthy, the better. Now we just need someone to redesign the speculum!
The Savvy Short
· Cervical cancer prevention and screening is one area of women’s health that has seen continuous advances and improvements. The most recent advances include tools that allow women to self-collect cervical samples.
· The FDA recently approved the Teal Wand, a device for collecting cervical samples at home that has shown results similar to samples collected by doctors.
· Right now, self-collection isn’t right for everyone, and at-home cervical cancer screening doesn’t replace the need for other routine medical care.
I applaud you for highlighting these new cervical cancer screening tools. I hope they lead the way to fewer pelvic exams. As a family physician, I disagree with your paragraph about the "exams" still being needed. Multiple organizations have reviewed the evidence and it is clear: regular pelvic examinations are not necessary. In fact, they were on the "Do not do" list from choosing wisely: https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-screening-pelvic.html
While a "check up" (i.e. talking about preventive care needs) is worthwhile, women should know that an "exam" is no longer needed unless there is a specific problem that needs to be assessed.
Finally, while gynecologists can certainly address much of women's healthcare, patients can also see family physicians and internists. These physicians are fully trained in taking care of preventive (and most other needs) of women. In my experience, these clinicians are less likely to do (unnecessary) exams.
Thank you for making it clear that patients have choice to the type of cervical cancer screening they want and the type of clinician they wish to see.