Innovations for Equitable Cervical Cancer Screening
Accessible screening tests and inclusive management strategies could reduce cervical cancer globally
Swathi Kodaikal, MSc, holds a master’s degree in biotechnology and has worked in places where actual science and research happen. Blending her love for writing with science, Swathi enjoys demystifying complex research findings for readers from all walks of life. On the days she doesn’t write, she learns and performs Kathak, sings, makes plans to travel, and obsesses over cleanliness.
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In 2021, the WHO updated its cervical cancer screening guidelines to encourage the use of HPV nucleic acid tests to detect precancerous lesions. Unlike traditional cytology, molecular screening tests involving HPV DNA and mRNA are technically accurate, sophisticated, and error-free/unbiased. Unfortunately, the price tags on such tests can be prohibitive—but newly developed technology may help alleviate the cost burden.
An inexpensive, integrated HPV screening test
Bioengineering professor Rebecca Richards-Kortum, PhD, and her team at Rice University, TX, have developed a novel DNA testing platform that greatly simplifies the HPV DNA screening equipment and procedure, thereby reducing the per-test price.
Researchers demonstrated an integrated test for HPV types 16 and 18—which cause well over half of all cervical cancers—using a prototype consisting of just two pieces of equipment. They evaluated the test’s performance using synthetic and provider-collected clinical samples in a high-resource setting in the US and self-collected clinical samples in a low-resource setting in Mozambique.
In both settings, the integrated test delivered reliable results in 45 minutes at a projected per-test price of less than $5, demonstrating the feasibility of a point-of-care HPV DNA screening test.
Toward inclusive, accessible HPV screening
About 90 percent of global new cervical cancer cases and deaths worldwide in 2020 occurred in low- and middle-income countries. Women from such resource-limited areas are often under-screened, likely due to barriers in understanding or access, fear of pain or embarrassment, cultural deprioritization of women’s health, or even negative provider attitudes.
The My Body, My Test-3 study was developed to assess the potential of at-home testing to address cervical cancer under-screening. In the Phase 3 trial, 665 under-screened women in North Carolina, aged 25 to 64, were mailed HPV self-collection tests and given appointment-scheduling assistance. The researchers reported that the uptake of cervical cancer screening nearly doubled (72 percent) when women received the kits versus when they received appointment-scheduling assistance alone (37 percent).
“We’re now working with clinical partners to identify women who might be overdue for screening through electronic medical records. We hope to provide the option of either mailing them a self-collection kit to use at home to mail back to us or handing a kit directly to them when they come into clinics for other services with the vision to eventually make self-collection a regular clinical provision,” said study co-author Noel T. Brewer, PhD, Gillings Distinguished Professor in Public Health, UNC Gillings School of Global Public Health, in a recent press release.
“People who are routinely screened very rarely progress to cervical cancer,” Richards-Kortum stated. “It’s people who have never been screened in their lives, or who get screened on really infrequent intervals, who are really at risk. That’s why it’s so critical to address the disparities that exist and think about new ways to deliver screening, diagnosis, and treatment.”