The FDA recently approved a tool for at-home HPV tests that could help some patients who can’t get to a clinician or struggle with Pap smears.
Many women dread getting their regular Pap smears. The procedure, which involves scraping cells from the cervix to check for HPV and cancer, is often uncomfortable for patients.
But a new at-home exam may offer another option for cervical cancer screening for patients who struggle getting Pap tests. The Food and Drug Administration recently approved a vaginal test made by Teal Health that allows patients to collect samples at home that can then be tested for human papillomavirus, which causes most cases of cervical cancer.
“It’s the kind of thing that, as a women’s health nurse practitioner, we’ve been advocating for a long time,” said Kathy Simmonds, a clinical professor of nursing and associate director of health programs at the Roux Institute at Northeastern University. “It’s an exciting development, especially for people who are more likely to not be able to get care or have been avoiding cervical cancer screening. This really will help people who have had difficulty accessing care for a variety of reasons.”
A Pap smear is performed by inserting a speculum into the vagina to hold the walls apart while a health care professional goes in and takes samples from the cervix. This sample is often tested for both HPV and cancerous or precancerous cells. Under current guidelines, women begin getting these screenings at 21 and continue to receive them every 3 to 5 years until they’re 65.
But it’s not uncommon for women to fall behind on screenings, especially people of color and women in rural areas.
Lack of access and overall discomfort with the procedure contribute to missing testing.
Simmonds and Jane G. Adams, director of the family nurse practitioner program and assistant clinical professor at Northeastern, both said they’ve seen patients in their practice who dread or avoid coming in for Pap smears due to the discomfort it causes, both physically and mentally.
The procedure can be especially intimidating for patients who’ve experienced sexual trauma or had a bad experience with medical providers.
“For people who have had a really negative experience, the Pap smear in the traditional way can be really traumatizing and humiliating,” Simmonds said. “There are a lot of currently marginalized groups that either grit their teeth and do a Pap smear or just don’t come at all who will benefit immediately from this new technology, people who just say I’d rather do it myself.
“This gives them a whole different way to take care of themselves that doesn’t require them to be in a position that makes them feel vulnerable. … I think anytime we take something that’s been highly medicalized and give it back to the people, to me, that is an empowering act.”
Some patients simply struggle to get to an office for an exam, whether it’s because they can’t take time off from work for an appointment, live far away from their clinician, or can’t find an appointment that fits their schedule. Others, like transgender patients, might be uncomfortable going into an office, Adams said, or might only see a primary care physician who doesn’t perform the procedure.
“I’ve been doing it for 27 years and I’ve had patients that I’ve taken care of for 27 years straight and they’re still like ‘I love coming to see you, but I hate having this done,’” Adams said. “Hopefully, now we’ve found an easier and less invasive way in order to get the information we need in order to prevent cervical cancer.”
But this at-home test will not necessarily replace Pap smears, at least not right away, said Northeastern experts.
Pap smears collect samples from the cervix that are usually tested for both HPV and precancerous or cancerous cells. The Teal at-home test collects a sample from the vagina that is tested for HPV. Patients will need to follow up if they test positive for HPV. This would lead to a Pap smear or colposcopy to screen for cancer.
Adams said that people who have HPV will probably also need to continue to get Pap smears for closer monitoring, as will patients who have other risk factors such as abnormal bleeding or are immunosuppressed. But this new technology could be another “tool in the toolbox,” she added, especially for lower-risk patients.
“There will be a discrete group of people for whom the at-home testing will become the standard of care,” added Simmonds. “I suspect that a lot of people will still want to go to a clinician and have a gynecologic exam. But I wonder if that will change over time as people get more comfortable with the effectiveness of this new method that everybody starts to feel really secure.”