In May 2024, the Food and Drug Administration (FDA) approved a self-collected vaginal sample to be tested for human papillomavirus (HPV), the infection that causes most cases of cervical cancer. In late 2024, the U.S. Preventative Services Task Force issued guidelines for patients 30 and older to use the alternative screening. This new process allows patients to collect the sample themselves instead of the typical internal pelvic exam, known as a Pap smear. Advocates for the self-collection test believe it will broaden access for cervical cancer screening.
Alis Panzera, DrNP, an associate clinical professor in Drexel University’s College of Nursing and Health Professions and a women’s health nurse practitioner, shared with the Drexel News Blog the importance of regular screenings and what this new testing option means for both patients and health care providers.
Why is it important to get screened regularly?
A Pap smear is a vital screening test for detecting precancerous changes and early-stage cervical cancer, where treatment is most effective. Regular screening significantly reduces cervical cancer incidence and mortality by identifying abnormalities early when they can be treated. Current guidelines aim to balance risks and benefits:
- Pap smears: Recommended every 3 years starting at age 21.
- Human papillomavirus (HPV) testing: Recommended every 5 years from age 30 to 65 or combined Pap smear and HPV testing (co-testing) every 5 years as an alternative.
Cervical cancer progresses slowly, so regular screening can detect persistent HPV infections or cellular abnormalities. Early detection allows for timely treatment, preventing progression to invasive disease.
It’s important to note that individual recommendations may vary depending on a patient’s medical history. A discussion with your health care provider is essential to determine the best screening approach for your unique needs.
What is the difference between the typical Pap smear and the new self-collection screening?
A typical Pap smear is conducted by a healthcare provider using a speculum to collect cervical cells during a pelvic exam. These cells are analyzed microscopically for abnormalities. If indicated, the sample may also be tested for HPV.
The self-collection method involves the patient collecting a vaginal sample using a swab. This test detects high-risk HPV infections that can lead to precancerous changes but does not identify cellular abnormalities.
The key differences are Pap smears assess cellular abnormalities directly, complementing HPV testing and self-collection eliminates the need for an in-office pelvic exam, enhancing accessibility and comfort.
What does this new screening option and guidance mean for health care providers and patients?
For health care providers, this option could improve screening rates, especially among underserved populations or individuals hesitant to attend in-person appointments. Increased screening may lead to earlier detection, timely intervention and reduced cervical cancer rates.
For patients, the self-collection offers greater convenience, privacy and accessibility for those uncomfortable with traditional exams. However, as self-collection does not directly assess cellular changes, further evaluation is needed if high-risk HPV is detected.
Regular screening, regardless of the method, remains crucial to preventing cervical cancer. Patients should discuss their screening options with their healthcare provider to make informed decisions that align with their medical history and personal preferences.
Are there any advantages or disadvantages to this new type of screening?
The advantages are that it simplifies access to screening, particularly for underserved or hesitant populations. HPV testing identifies high-risk infections, offering an effective screening method. It is FDA-approved and supported by national guidelines, so self-collection may reduce missed screenings.
But there are also disadvantages. Improper sampling could lead to inconclusive or inadequate results. Self-collection does not evaluate cytology or other reproductive organs, potentially delaying the detection of non-HPV-related abnormalities. Additionally, there is the missed opportunity for other comprehensive health screenings, including sexually transmitted infection (STI) testing, family planning, mental health, violence prevention and cancer and heart health assessments that are performed at annual or in-office exams.
As a nurse practitioner, what do you recommend for your patients regarding cervical health?
As a women’s health nurse practitioner, I base my practice on the latest evidence and recommendations. My guidance includes:
- Vaccination: I strongly encourage HPV vaccination for individuals aged 9–26 to prevent high-risk HPV infections.
- Screening: I recommend a Pap smear every 3 years for patients 21-29 years old. I recommend HPV testing every 5 years, co-testing every 5 years, or Pap smear every 3 years for patients 30-65 years old.
I emphasize the importance of annual gynecological care for overall reproductive health, including screening and evaluation for other conditions. For those unable to attend in-person visits, self-collection can be an alternative, ensuring patients understand the importance of proper technique.
Additionally, I stress that a patient’s medical history and current health status may influence screening recommendations. I encourage open communication with health care providers to ensure a personalized and effective approach to cervical health.
Reporters interested in speaking with Panzera should contact Annie Korp, assistant director, News and Media Relations, at 215-571-4244 or amk522@drexel.edu.
