Bringing new possibilities to cervical cancer prevention

A new MUSC pilot study is exploring whether self-collection could shape the future of cervical cancer screening by giving patients another option for how they are screened.

Led by MUSC Hollings Cancer Center researcher Trisha Amboree, Ph.D., the study is examining how patients feel about self-collection for testing for human papillomavirus (HPV), the infection linked to 90% of cervical cancer cases. While HPV vaccination has dramatically reduced rates of the virus and related cancers, screening remains an essential pillar of prevention and detection because not everyone is vaccinated, and vaccines do not protect against every cancer-causing HPV type.

The project is still in its early stages. However, researchers say it represents an important step toward understanding whether self-collection could one day expand screening access for women who currently go unscreened.

“We haven’t assessed self-collection at MUSC yet,” Amboree said. “While acceptability has been high in other settings, we don’t yet know how our patients feel about it or if they like it. This is a necessary step to move toward getting this option broadly available within our system.”

Currently, cervical cancer screening involves a Pap test and/or HPV test – both of which require that a healthcare provider insert a speculum into the vagina to collect cells from the cervix. With self-collection, a woman collects the sample herself using a long swab. Research has shown that this method performs similarly to clinician-collected samples in identifying high-risk HPV infections that can lead to precancer or cancer.

What makes self-collection promising is its potential to reduce barriers that prevent some women from getting screened.

“There are women who are not able to tolerate a pelvic exam,” Amboree said. “There may also be issues with accessing care, for which home-based testing can be a good option.”

For now, the self-collection is taking place within a clinic. MUSC Health OB-GYNs Britton Gibson, M.D., and Victoria Keiser, M.D., will offer the option to their patients. At this stage, the study team is focusing on understanding whether patients find self-collection to be acceptable, comfortable and useful.

“I believe everyone should have access to routine gynecologic care and cervical cancer screening – but the reality is that traditional office exams aren’t always possible for every patient,” Gibson said. “Self-collected HPV testing gives us another way to reach people who may not be open to screening because of trauma history, physical or geographic limitations or cost-related barriers to care. If we can identify high-risk HPV infections earlier, hopefully we can connect these individuals to the follow-up care they need to prevent cervical cancer.”

Although the pilot is being conducted in clinics rather than at home, Amboree said the long-term vision is to understand more fully how self-collection could be integrated into health systems to reach women who are due or overdue for screening. She emphasized that the goal is not to replace screening for women who already receive traditional provider-performed exams but to provide another option for people who face barriers to care or avoid screening altogether.

The researchers plan to enroll about 100 patients over the course of a year. Support for the project came from Matt Prisby, through the Sheryl Sirisky Prisby Foundation, with Hollings researcher Joe Delaney, Ph.D., helping to connect the team with the funding needed to launch the feasibility study.

HPV infections are extremely common, Amboree explained, but persistent high-risk infections are what concern providers most because they can lead to precancerous changes or cancer over time.

Nationally, roughly 25% of eligible women are not up to date on cervical cancer screening. But previous research suggests that self-collection could help to close that gap. Amboree was part of a team of researchers who conducted a randomized clinical trial of almost 2,500 women and found that self-collection more than doubled cervical cancer screening participation among persistently underscreened women.

That matters because cervical cancer is highly preventable when abnormalities are detected early. According to the American Cancer Society, five-year survival for localized cervical cancer is about 91%, but survival drops to 20% once the disease has spread.

“Cervical cancer is one of the most preventable cancers when screening occurs regularly,” Kesier said. “If self-collection helps even a portion of patients complete recommended screening who might otherwise delay or avoid testing, it could have a meaningful impact on early detection and prevention.”

Federal guideline updates and insurance coverage changes are paving the way for self-collection to become more widely available. Amboree noted that primary HPV testing with self-collection is now endorsed as an option under federal screening guidelines, and it is expected to gain broader insurance coverage beginning next year.

If the pilot is successful, it could lay the groundwork for larger implementation studies examining how self-collection could be sustainably integrated into clinical workflows, laboratory systems and electronic health records across the MUSC Health system.

For now, Amboree hopes the study keeps attention on the importance of cervical cancer screening and prevention.

“We have a cancer that we can prevent,” she said. “It’s a disease that we can intervene early on and have good outcomes. The more people we can reach with effective screening, the more cervical cancers and related deaths we can prevent.”