Opinion: Finally, a cervical cancer screening that allows women more autonomy

Editor’s Note: Dr. Megan L. Ranney is an emergency physician and dean of Yale School of Public Health. Dr. Monique Rainford is an obstetrician and gynecologist, and assistant professor of Clinical Obstetrics, Gynecology and Reproductive Science at the Yale School of Medicine. She is author of the book “Pregnant While Black: Advancing Justice for Maternal Health in America.” The views expressed in this commentary are their own. View more opinion at CNN.

Although cervical cancer remains the fourth most common cancer for women worldwide, it is easily treatable if detected early. It’s almost always caused by a few high-risk strains of human papillomavirus (HPV), so it can be almost fully eliminated by the HPV vaccine. And for people who have not received the vaccine, regular screening can prevent cervical cancer or allow it to be diagnosed early before it has spread.

Unfortunately, too many people can’t or don’t access cervical cancer screening.

So, we’re excited to see the news about the US Food and Drug Administration’s approval of new methods that allow patients to collect their own samples and may expand Americans’ access to testing for HPV, the virus that causes most cases of cervical cancer. We just wish this approval had come earlier.

Traditionally, to get screened for cervical cancer, the healthcare provider has to examine the patient with a speculum (a plastic or metal instrument used to visualize the inside of the vagina and the cervix) and then inserts a very small brush into the cervix to get a sample of cells. This sample is examined under a microscope (a “Pap smear”) and can also be sent for HPV testing.

People miss out on this traditional cervical cancer screening for a lot of reasons. They may not know that they should be tested. They may not have insurance or a doctor who can do the test. And some people actively avoid testing because of fear, stigma or discomfort with the exam. The speculum exam and Pap smear can be uncomfortable, anxiety-producing or even painful, particularly for women with a history of sexual or birth trauma. And for non-binary or trans people, there may be real fear of judgment.

This is why the new self-screening option is so terrific: With the newly approved tests, a patient can gather a sample of cells themself by using a swab (like a Q-tip) from the inside of the vagina. It’s more private, easier and quicker. And it avoids the need for a traditional speculum exam for many people. (Note: A clinician-obtained speculum exam and Pap smear is still recommended for people with certain conditions such as HIV or with symptoms such as abnormal bleeding, and some organizations still recommend regular Pap smears in addition to HPV testing.)

These self-collected vaginal swabs are a much-needed option for other reasons, too. They may allow expansion of screening options to locations with few clinicians, thereby improving access to this important test. They may also improve a person’s sense of control over their own bodies, reducing fear of the procedure, which can feel invasive.

But here’s the frustration: Getting these self-collected sample methods approved in 2024 means that the United States is already behind the times.

Self-screening for HPV has been available in other countries – ranging from Australia to Albania – for years. There is strong research showing that self-sampling is as good as provider-collected samples. It is baffling that it took this long for these self-collection approaches to be approved in the US.

We also hope that the approval will soon go further, to include options for self-testing at home.

Currently, the FDA’s approval of these self-collection methods still requires a visit to a hospital or clinic. Meanwhile, home testing (for example, for sexually transmitted infections) has already been shown to be effective in increasing screening in the US. One study of clinical trial data even showed that a home testing option for HPV doubled screening rates amongst low-income and rural women, and increased screening rates by 1.5 times among groups with certain kinds of insurance.

Of course, substituting a home-collected swab for a visit with a doctor is not always ideal. A doctor visit can identify and provide counseling on lots of issues other than cervical cancer – ranging from birth control to painful periods to depression. Even if patients complete this self-screening in a lab, they may miss out on the expertise and guidance they would receive from their doctor. And it may also result in positive HPV tests not receiving follow-up treatment.

This line of thinking is the argument for not approving home tests for HPV. However, meeting the needs of people who otherwise would not get screened – and who aren’t seeing a doctor anyway – outweighs these concerns, to us. Isn’t at-home screening better than someone not being screened at all?

There are lots of things about the US medical and public health systems that need improvement: educating the public about the importance of cancer screening, helping patients obtain and understand test results, covering the cost of testing and – most importantly – creating systems that provide easy access to evaluation and treatment. But those improved systems are needed whether or not we approve self-testing, home testing or any other testing tools.

We strongly recommend that all women and patients with female pelvic organs learn about their reproductive system and how to keep it healthy. Get the HPV vaccine to reduce your cervical cancer risk. Complete your recommended cervical cancer screening. Continue to use other effective risk-reduction practices such as condoms and, if appropriate, pre-exposure prophylaxis against HIV and other sexually transmitted infections.

And, yes, ask your health care provider about whether you can do a self-collected swab for HPV as part of your regular cervical cancer screening.

But most of all, we hope that all of us will keep advocating for the information about and access to tests that can help us improve our community’s well-being.

Because knowledge — whether about our HPV status, or any other aspect of our health — is power.