Cervical Cancer Screening: HPV Screening vs Pap Tests

A recent Harris Poll survey of women in the US, UK, and Sweden has found a disparity in access to, as well as a lack of education around, cervical cancer screening. Based on these results, experts at Becton, Dickinson, and Company (BD) have recommended options to improve screening access, as well as identified where healthcare professionals and communicators need to provide clearer dissemination of information to patients. 

According to the WHO, cervical cancer caused 342,000 deaths in 2020, globally, and is the fourth most common cancer in women globally. The vast majority of deaths from cervical cancer (90 percent) occur in lower- and middle-income countries. Despite this, a robust educational, screening, and prevention approach can help medical professionals eliminate this deadly cancer.

Survey highlights barriers to cervical cancer screening

Identifying and treating cervical cancer early is the best means of helping a patient. Unfortunately, the recent poll shows that many women in the surveyed countries have delayed gynecology visits (67 percent in the US, 62 percent in Sweden, and 59 percent in the UK). 

The primary reason given for why these visits were delayed was due to discomfort and embarrassment around pelvic exams. Respondents also expressed lack of access to an OB/GYN and difficulty with insurance coverage as reasons for delaying an exam, this was especially true of US respondents. Many women in the US also felt that there was a lack of health equity, with only 60 percent reporting that they believe all racial and ethnic groups in the US have equal access to health care. 

These results show a troubling barrier to accessing traditional screening methods to prevent cervical cancer. However, there is some good news—a shift away from the traditional way of thinking about cervical cancer screening toward self-collection. This shift that could greatly improve cervical cancer screening. 

Cervical cancer screening: Pap vs HPV Tests 

Increasing the number of at-risk women being tested depends not only on improving access to testing but also on developing and communicating better screening methods. 

The traditional test that detects irregularities in cervical cells is the Pap test. While Pap tests are effective, they do require specialized tools and expertise to perform, meaning they must be performed in a clinic by a professional. 

Recently, clinicians are increasingly favoring HPV screening as an alternative. Almost all cervical cancer is caused by the human papillomavirus (HPV), which is a common sexually transmitted infection. Testing for HPV instead presents a more sensitive, less invasive screening method that causes less discomfort and can even be self-collected.

“When it was determined that HPV was a more sensitive screening test than cytology, many countries switched to HPV as the initial screen instead of cytology. And at the same time, we realized that that doesn't require the clinical expert, the speculum exam,” says Jeff Andrews, MD, FRCSC, a board-certified obstetrician and gynecologist, vice president, Medical and Scientific Affairs at BD.

Despite it being well known in the healthcare community that HPV tests are the better option, the Harris Poll survey reported that 73 precent of Swedish, 59 percent of US, and 46 percent of UK women incorrectly believe that the Pap test is more accurate for detecting cervical cancer. These results highlight a clear knowledge gap in patient communication and education.

A need for better patient education

While most women feel that cervical cancer screening is a vital piece of managing their health, a little over 50 percent of survey respondents find guidance around screening to be confusing. “It's clear from this survey and the other surveys that there's a real need to communicate,” says Andrews. “To date, [healthcare providers] haven't done a great job, generally, communicating directly to women about this.”

Andrews also highlights the importance of informing the public about both the distinction between Pap and HPV tests and the evidence that HPV testing is typically the better option. Switching to HPV testing also opens up opportunities for self-collection methods.

Self-collecting

Because the tests for HPV require little to no specialized equipment or knowledge, samples can be self-collected by patients. This means these tests are less invasive, cause less discomfort, and are a cheaper option. Many countries in Europe have begun implementing and evaluating self-collection methods to make sure they are as effective as traditional sampling done by an expert. 

“The goal is that the self collection should be equivalent in sensitivity. It may be that the self collection is less specific, in other words, generating more positives,” says Andrews. “But that's of lesser import than making sure [the tests are] as sensitive as the clinician collected cervical sample in order to show that you have the safety to stand behind this alternative sampling method. So that'll be the standard to be met. And we've already demonstrated that in Europe.”

Andrews also says there are still regulatory hurdles and requirements, especially in the US, around self-collection tests. “The FDA will require that the tests be ordered by a clinician. And the reason for that is to make certain that women receive a result and an explanation of the result and any follow up that's necessary. So now, to do any lab test for HPV, there has to be a clinical order.”

Beyond regulatory concerns, the impacts that self-collection may have on the clinical lab space aren’t yet known. Any progress is going to require extensive and open communication between advocacy groups, regulators, stakeholders, healthcare providers, and patients. If self-collection is completed at doctor offices, the required changes may be small, but if the process moves to at-home collection, things may become more complex. At-home collection would require developing testing kits that can be delivered to patients’ homes then shipped by the patient back to the lab for processing, says Andrews. The results would then be sent to clinicians, who would relay them to their patients.

Improving the odds

The recent survey results have brought to light troubling knowledge gaps around cervical cancer screening and accessibility. Clinicians and advocacy groups need to find new and better ways to effectively communicate the guidance around cervical cancer screening, as well as encourage policy makers to shift away from Pap tests toward HPV tests. At the same time, pushing for more self-collection and at-home testing can help people feel more comfortable getting HPV tests, improving the odds of catching and treating cervical cancer earlier.